Introduction

Vasculitis refers to inflammation of the blood vessels, a condition that can lead to a wide range of health problems depending on which vessels and organs are affected. While vasculitis is often discussed as a single disease, it actually encompasses a group of disorders that vary widely in severity, symptoms, and outcomes. One critical area of variation is age—vasculitis can appear in both children and adults, but the types, causes, symptoms, and long-term consequences can differ significantly between these two populations.

Understanding the key differences in how vasculitis presents and progresses in children versus adults is vital for early diagnosis, effective treatment, and long-term management. This article explores those differences, offering a clear and accessible comparison of vasculitis across age groups.

What Is Vasculitis?

Vasculitis involves inflammation of blood vessels, which may cause the vessel walls to thicken, weaken, narrow, or scar. This can restrict blood flow and damage organs and tissues. Vasculitis may affect arteries, veins, or capillaries, and can range from mild and localized to severe and systemic.

There are numerous types of vasculitis, such as:

  • Henoch-Schönlein purpura (now known as IgA vasculitis)

  • Kawasaki disease

  • Giant cell arteritis

  • Granulomatosis with polyangiitis

  • Takayasu arteritis

  • Microscopic polyangiitis

The cause of vasculitis is often unknown, but in many cases, it involves immune system dysfunction. Sometimes it is triggered by infections, medications, or autoimmune diseases.

Common Types of Vasculitis in Children

Vasculitis in children tends to be more limited in type but still requires prompt attention. The most common forms include:

1. IgA Vasculitis (Henoch-Schönlein Purpura)

This is the most common form of vasculitis in children and typically affects children between the ages of 2 and 11. It causes small blood vessels to become inflamed, especially in the skin, gastrointestinal tract, joints, and kidneys. Classic symptoms include a purplish skin rash (purpura), abdominal pain, and joint inflammation.

2. Kawasaki Disease

This primarily affects children under 5 years old and involves inflammation of medium-sized arteries throughout the body, especially the coronary arteries. It presents with high fever, red eyes, cracked lips, swollen hands and feet, and rash. Kawasaki disease is notable for its potential to cause heart complications if not treated early.

3. Takayasu Arteritis (rare in children)

Although more commonly seen in young adults, this condition can also occur in adolescents. It affects large arteries such as the aorta and its branches, leading to symptoms like fatigue, weak pulses, and high blood pressure.

Common Types of Vasculitis in Adults

In contrast, adults experience a broader spectrum of vasculitis types, and these forms tend to be more chronic and complex. Common types include:

1. Giant Cell Arteritis (Temporal Arteritis)

Typically affects individuals over 50. It involves inflammation of large and medium-sized arteries, especially those in the head and neck. Symptoms include headache, jaw pain, vision disturbances, and scalp tenderness. It requires urgent treatment to avoid vision loss.

2. Granulomatosis with Polyangiitis (GPA)

This affects the small and medium vessels, especially in the respiratory tract and kidneys. Symptoms can include chronic sinusitis, nosebleeds, cough, and blood in the urine.

3. Microscopic Polyangiitis (MPA)

Similar to GPA, MPA affects small vessels and can involve the kidneys, lungs, and skin. Fatigue, weight loss, and high blood pressure are common.

4. Polyarteritis Nodosa (PAN)

This affects medium-sized arteries and can damage various organs such as the skin, heart, kidneys, and intestines. It is often associated with hepatitis B infection.

Differences in Symptoms and Presentation

While inflammation of blood vessels is the core issue in all types of vasculitis, the symptoms in children and adults often differ because of variations in the immune response, affected organs, and disease progression.

In Children:

  • Onset is usually acute with clear, visible signs like rash or swelling.

  • Skin involvement is common, often seen as purpura or bruising.

  • Joint pain and abdominal pain may be prominent.

  • Kidney involvement occurs but is often milder and reversible if treated early.

  • Heart complications, particularly in Kawasaki disease, can develop if untreated.

In Adults:

  • Symptoms may be more vague, such as fatigue, weight loss, or low-grade fever.

  • Chronic progression is more common, especially in systemic forms.

  • Organ involvement is more serious and can be long-term or permanent, especially in the kidneys, lungs, and nervous system.

  • Neurological symptoms (numbness, tingling, or stroke) are more frequently reported.

  • Higher risk of complications such as aneurysms, thrombosis, or organ failure.

Diagnosis: How It Differs by Age

Diagnosing vasculitis can be complex in both age groups, but the approach varies slightly:

In Children:

  • Diagnosis often relies on clinical signs (e.g., rash, joint swelling).

  • Urinalysis may reveal kidney involvement.

  • Blood tests might show elevated inflammatory markers (CRP, ESR) and presence of IgA antibodies.

  • Imaging is sometimes used to check organ involvement but may not be needed in mild cases.

In Adults:

  • Diagnosis typically involves a combination of lab work, imaging, and biopsy.

  • Blood tests for specific autoantibodies (e.g., ANCA) are more frequently used.

  • Tissue biopsy may be required to confirm the type of vasculitis and rule out other conditions.

  • More advanced imaging (CT angiography, MRI) is often necessary to evaluate large vessel involvement.

Treatment Approaches

Treatment goals in both children and adults are to reduce inflammation, prevent organ damage, and manage symptoms. However, the therapeutic approach can differ due to age, comorbidities, and medication tolerance.

In Children:

  • Corticosteroids are typically the first line of treatment.

  • Immunosuppressive medications are used less frequently and usually reserved for severe cases.

  • IVIG (Intravenous Immunoglobulin) is standard in Kawasaki disease.

  • Prognosis is generally favorable with timely intervention.

In Adults:

  • Corticosteroids are also first-line but often combined with long-term immunosuppressants such as methotrexate, azathioprine, or cyclophosphamide.

  • Biologic agents (e.g., rituximab) may be used in resistant or relapsing cases.

  • Because of the chronic nature of vasculitis in adults, long-term monitoring and medication adjustment are often necessary.

Prognosis and Long-Term Outlook

Children:

  • The majority recover completely, especially with prompt diagnosis and treatment.

  • Some may experience mild kidney issues or joint stiffness for a period.

  • Long-term complications are rare but can occur if the disease is severe or untreated.

Adults:

  • Prognosis depends heavily on the type of vasculitis and how early treatment begins.

  • Many forms are relapsing-remitting, requiring ongoing care.

  • There is a higher risk of permanent organ damage, and some forms can be life-threatening if not controlled.

Conclusion

While vasculitis affects both children and adults, it presents differently across age groups in terms of symptoms, severity, diagnosis, and treatment. Children often experience more acute but reversible forms, while adults are more likely to deal with chronic, systemic forms that carry greater risk for long-term complications. Understanding these differences is key for timely diagnosis and effective management.

By recognizing the unique features of vasculitis in both children and adults, healthcare professionals and families can respond appropriately and improve outcomes. With medical advances, early detection, and individualized care plans, many individuals with vasculitis—regardless of age—can lead healthy and productive lives.