Granulomatosis with Polyangiitis (Wegener’s)

Granulomatosis with polyangiitis (GPA), formerly called Wegener's granulomatosis, is an autoimmune disorder that occurs when the body's immune system attacks and destroys healthy tissue. 

This condition causes inflammation that reduces or stops the flow of blood to organs in the body. The condition mostly affects the respiratory system. This includes the sinuses, nose, windpipe, and lungs. It can also affect the kidneys. But it can damage any organ in the body.

GPA is not common and can start at any age. The exact cause of granulomatosis is unknown.

Most people with GPA first have vague symptoms that may include:

• Tiredness or exhaustion.

• Joint pain.

• Upper respiratory symptoms that don’t respond to treatments for allergies or colds:

  • Runny nose.

  • Bloody discharge.

  • Sinus pain.

  • Congestion.

  • Blockage of the eustachian tubes in the ears.

  • Cough.

  • Cough that produces blood.

  • Shortness of breath.

• Eye infections, redness, burning, or pain.

• Weakness.

• Skin sores or ulcers.

• Hoarseness.

• Fever.

• Night sweats.

To diagnose GPA, your healthcare provider may do the following:

• Take your health history.

• Do a physical exam.

• Review of your symptoms.

• Order blood tests.

• Order antineutrophil cytoplasmic antibody (ANCA) blood test.

• Order imaging tests, such as chest X-rays or CT scans of the lungs or sinuses.

• Do a biopsy from an affected organ to see if the condition is present.

• Order urine tests.

Some of these tests can help rule out other causes of your symptoms. They may not be able to confirm the diagnosis. A biopsy is the only way to know for sure if it’s GPA.

Most people with GPA can be treated. But the medicines used to treat this condition could have side effects of their own. Be sure to talk about these side effects with your healthcare provider.

These are common medicines used in treatment:

• Corticosteroids. This steroid helps reduce inflammation. Long-term steroid use can affect your bone health, so your healthcare provider may also watch and treat changes in your bone density.

• Rituximab. This is an antibody against certain immune cells (B-cells). These cells help cause the autoimmune state in GPA.

• Cyclophosphamide. This is used to treat active GPA.

  • This medicine may be given to keep symptoms in remission for 1 to 2 years. 

  • This is an alternative to methotrexate.

  • This medicine may be given along with prednisone to treat GPA and bring about remission.

• Antibiotics. Certain infections are more common among people with this condition. Antibiotics may be given to treat or prevent infection.

GPA may come back even after successful treatment. Continue to follow up with your healthcare provider, even when you are in remission.

Ongoing GPA can cause:

• Collapse of cartilage in the nose.

• Infections of sinuses and ears.

• Hearing loss.

• Kidney damage.

• Kidney failure.

• Death.

Call your healthcare provider if you have the symptoms listed above. This is especially true if you have tried over-the-counter treatments that seem appropriate, such as allergy medicines, with no success.

Always call your healthcare provider if you have changes in vision. Call if you have a cough that produces bloody mucus. These may be symptoms of granulomatosis with polyangiitis (GPA) or another serious health problem.