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Personalized Therapy and Clinical Outcome for Vasculitis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology & Rheumatology".

Deadline for manuscript submissions: 25 August 2026 | Viewed by 1654

Special Issue Editor


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Guest Editor
Rheumatology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy
Interests: rheumatology and immunology; autoimmune diseases; vasculitis; SLE; connective tissue diseases; interstitial lung disease; rheumatoid arthritis; capillaroscopy; personalized medicine
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Special Issue Information

Dear Colleagues,

Systemic vasculitides are a heterogeneous group of immune-mediated diseases characterized by inflammation of blood vessels, leading to tissue ischemia, organ dysfunction, and significant morbidity. They are traditionally classified according to the size of the affected vessels into small, medium, or large vessel vasculitis. Although many forms are rare, they often present with severe, life-threatening manifestations and multi-organ involvement, requiring complex clinical management. Despite advances in classification and therapeutic strategies, the management of vasculitis remains challenging. The heterogeneity of clinical presentation, the lack of robust biomarkers of disease activity, and the frequent need for multidisciplinary care complicate treatment decisions. Conventional immunosuppressive regimens have improved survival, but relapses, treatment-related toxicity, and incomplete disease control are still common. In recent years, the concept of personalized therapy has gained increasing relevance. Advances in immunopathogenesis, the identification of novel biomarkers, and the integration of imaging and genetic/epigenetic data have paved the way for individualized treatment strategies. Tailoring therapy to disease subsets, serological profiles, and patient characteristics holds promise for optimizing efficacy while minimizing adverse effects. Equally important is the evaluation of long-term clinical outcomes, including organ damage, quality of life, and treatment sustainability, which are essential to guide therapeutic decisions. This Special Issue, entitled “Personalized Therapy and Clinical Outcome for Vasculitis”, aims to provide a comprehensive overview of current knowledge and future perspectives in the field. Contributions will address innovative therapeutic approaches, prognostic markers, and outcome measures, highlighting the potential of personalized medicine to transform clinical practice. By integrating translational research with real-world clinical data, this collection seeks to advance our understanding of vasculitis and support the development of individualized management pathways that improve patient outcomes.

Dr. Giulia Cassone
Guest Editor

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Keywords

  • immune-mediated systemic vasculitis
  • personalized therapy
  • treatment
  • outcome
  • biomarkers
  • risk factors
  • management
  • multidisciplinary care

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Published Papers (2 papers)

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Research

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13 pages, 1164 KB  
Article
Effect of IV Iloprost on Distal Flow in Buerger’s Disease: Correlation with CT Perfusion
by Nilgün Yazıksız, Edanur Karapınar, Celal Caner Ercan, Birol Akdoğan, Gozde Oztan and Nilgün Bozbuğa
J. Clin. Med. 2026, 15(4), 1391; https://doi.org/10.3390/jcm15041391 - 10 Feb 2026
Viewed by 456
Abstract
Objectives: Revascularization in thromboangiitis obliterans (TAO) is limited by distal small-vessel involvement and poor blood flow; no curative treatment exists. This study aimed to evaluate the effect of intravenous iloprost (IVI) on distal perfusion using computed tomography (CT) perfusion imaging and to [...] Read more.
Objectives: Revascularization in thromboangiitis obliterans (TAO) is limited by distal small-vessel involvement and poor blood flow; no curative treatment exists. This study aimed to evaluate the effect of intravenous iloprost (IVI) on distal perfusion using computed tomography (CT) perfusion imaging and to correlate perfusion changes with clinical outcomes, with a focus on treatment duration. Methods: This retrospective cohort study was conducted at a single tertiary cardiovascular surgery center. Thirty-three patients (32 men and 1 woman) with confirmed TAO treated with IVI were screened. Clinical data, including ankle–brachial index (ABI), claudication distance, and pre- and post-treatment CT perfusion parameters, were obtained from outpatient records. Patients were grouped according to IVI duration: 0 days (n = 8), 7 days (n = 7), 14 days (n = 10), and 21 days (n = 8). One patient was excluded due to incomplete data, leaving 32 patients for analysis. Results: IV iloprost therapy resulted in significant improvements in ABI, claudication distance, and CT perfusion parameters, particularly in the 14- and 21-day treatment groups. No statistically significant differences were observed between the 14- and 21-day regimens; however, both were superior to shorter or no treatment. The 21-day group demonstrated the most consistent overall improvement. Treatment efficacy was independent of active smoking status, and patients with baseline ABI > 0.8 showed a more favorable response. Conclusions: Intravenous iloprost is clinically effective in TAO patients. Improvements in CT perfusion strongly correlate with ABI and claudication distance, suggesting that CT perfusion may serve as an early marker of treatment response and a useful adjunctive tool in TAO assessment. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcome for Vasculitis)
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12 pages, 1250 KB  
Case Report
PR3-ANCA-Associated Vasculitis in IgGκ MGUS: A Fatal Case of Rapidly Progressive Glomerulonephritis
by Carlos Berrocal, Álvaro Arbeláez-Cortés, Alyi Arellano, Antonio Peña, H. A. Nati-Castillo, Nancy Mejia, Alice Gaibor-Pazmiño, Marlon Arias-Intriago and Juan S. Izquierdo-Condoy
J. Clin. Med. 2026, 15(7), 2554; https://doi.org/10.3390/jcm15072554 - 27 Mar 2026
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Abstract
Background: Rapidly progressive glomerulonephritis (RPGN) is a severe nephrological emergency, frequently secondary to anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. In older adults, the coexistence of comorbidities and monoclonal gammopathy of undetermined significance (MGUS) makes it difficult to distinguish between ANCA vasculitis and monoclonal [...] Read more.
Background: Rapidly progressive glomerulonephritis (RPGN) is a severe nephrological emergency, frequently secondary to anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. In older adults, the coexistence of comorbidities and monoclonal gammopathy of undetermined significance (MGUS) makes it difficult to distinguish between ANCA vasculitis and monoclonal gammopathy of renal significance (MGRS), which differ in prognosis and treatment. The coexistence of PR3-ANCA-associated vasculitis and MGUS is uncommon and sparsely documented. Case Presentation: A 72-year-old woman with hypertension and type 2 diabetes presented with acute deterioration and rapidly progressive renal failure, requiring hemodialysis. She had subnephrotic proteinuria, hematuria, and an active urinary sediment. The autoimmune workup showed ANCA negativity using immunofluorescence, but PR3-ANCA positivity using ELISA. Hematologic characterization documented an IgG kappa monoclonal spike; no bone lesions, amyloidosis, or criteria for multiple myeloma were found; and the patient was classified as MGUS. Renal biopsy revealed necrotizing extracapillary pauci-immune glomerulonephritis with cellular and fibrocellular crescents and no monoclonal deposits, consistent with PR3-ANCA vasculitis. Induction therapy with methylprednisolone pulses and oral prednisone was initiated; cyclophosphamide was not administered because of catheter-associated Staphylococcus aureus bacteremia and upper gastrointestinal bleeding complicated by disseminated intravascular coagulation. The patient died on day 25 due to infectious and hemorrhagic complications. Conclusions: This case provides additional documentation of an uncommon overlap between PR3-ANCA-associated vasculitis and MGUS in a Latin American patient and highlights the role of renal biopsy in distinguishing MGRS from pauci-immune vasculitis in the presence of paraproteinemia. It also underscores the need to tailor immunosuppression in frail older adults, balancing disease control against the risk of severe infection. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcome for Vasculitis)
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