A persistent inflammation affecting blood vessels and potentially leading to serious thrombotic complications, even in young individuals with no known risk factors – this is the reality of systemic vasculitis, a group of rare autoimmune diseases which, if not promptly recognised and treated, can compromise vital organs such as the heart, kidneys, lungs and brain.

These conditions are the focus of a study published in Nature Reviews Rheumatology, one of the world’s most prestigious journals in the fields of immunology and rheumatology. The study is coordinated by Professor Giacomo Emmi, immunologist, lecturer in Internal Medicine at the University of Trieste, Head of the Department of Clinical Medicine and Scientific Coordinator of ASUGI (local health authority).

The article, the result of a coordinated review effort involving leading research centres in Italy, Sweden, Russia, Turkey and Australia, provides an overview of the thrombotic and cardiovascular manifestations associated with vasculitis. It also proposes new treatment strategies based on an anti-inflammatory approach.

The topic will be the subject of a presentation by Professor Emmi during the European Vasculitis Society (EUVAS) congress, being held for the first time in Trieste from 21st to 24th May, and bringing together over 400 specialists from across Europe. The congress is a key event for clinicians and researchers working in this area and is noted for its strongly multidisciplinary approach. Emmi is a member of the society’s board and part of the organising committee for the event.

"Our work," explains Emmi, "shows that in many forms of vasculitis, thrombosis is not an isolated event, but a direct consequence of vascular inflammation. In such cases, anticoagulants alone may be insufficient and must be combined with immunological therapy. A deeper understanding of the mechanisms underlying these findings changes the therapeutic approach and may open new avenues for other chronic inflammatory and non-inflammatory diseases as well."

Among the types of vasculitis examined in the review are:

• Eosinophilic granulomatosis with polyangiitis – a disease primarily affecting the respiratory tract, heart and peripheral nervous system;
• Behçet’s syndrome, which involves blood vessels of varying calibre and is characterised, among other things, by inflammatory thrombotic events.

The publication focuses on:

• the differences between arterial and venous thrombotic events;
• therapeutic management at different stages of the disease;
• and the various pathogenetic mechanisms that can inform clinical decision-making.

The study, available online via the Nature platform, represents a significant contribution to the international discourse on systemic autoimmune diseases, a constantly evolving field of medicine.

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Full Study Published in Nature Reviews Rheumatology         
Arterial and venous thrombosis in systemic and monogenic vasculitis
Federica Bello¹˒¹⁵, Filippo Fagni²˒³˒¹⁵, Giacomo Bagni⁴, Catherine L. Hill⁵˒⁶, Aladdin J. Mohammad⁷˒⁸, Sergey Moiseev⁹, Iacopo Olivotto¹˒¹⁰, Emire Seyahi¹¹ & Giacomo Emmi¹²˒¹³˒¹⁴

1. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
2. Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
3. Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
4. Department of Rheumatology and Inflammatory Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
5. Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
6. Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
7. Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
8. Department of Medicine, Karolinska Institute, Stockholm, Sweden
9. Department of Internal Medicine and Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russia
10. IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
11. Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
12. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
13. Department of Internal Medicine, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
14. European Reference Network ReCONNET, Trieste, Italy
These authors contributed equally: Federica Bello, Filippo Fagni