What are the key clinical features that suggest a diagnosis of systemic vasculitis in a primary care setting?

Key clinical features suggesting systemic vasculitis in primary care include:

• Constitutional symptoms such as unexplained persistent fever, weight loss, and fatigue, which often precede other manifestations and raise suspicion of systemic inflammation NICE NG143 Nwannunu et al. 2020.
• Multisystem involvement signs, including skin changes like palpable purpura or livedo reticularis, which indicate small to medium vessel inflammation Chevet et al. 2023.
• Musculoskeletal symptoms such as arthralgia or myalgia without clear alternative diagnosis, commonly reported in systemic vasculitis NICE NG143 Nwannunu et al. 2020.
• Neurological features including peripheral neuropathy or central nervous system symptoms like headache, confusion, or stroke-like episodes, which may reflect CNS vasculitis involvement Amin et al. 2023.
• Renal manifestations such as haematuria or proteinuria detected on urinalysis, suggesting glomerulonephritis secondary to vasculitis NICE NG143 Chevet et al. 2023.
• Respiratory symptoms including persistent cough, haemoptysis, or nasal crusting and sinus pain, which are common in ANCA-associated vasculitis Chevet et al. 2023.
• Laboratory findings supportive of systemic inflammation, such as elevated inflammatory markers (ESR, CRP), anaemia of chronic disease, and sometimes positive ANCA serology, although these require specialist confirmation Nwannunu et al. 2020Chevet et al. 2023.

In primary care, the combination of unexplained systemic symptoms with signs of multisystem involvement—especially skin, renal, neurological, and respiratory—should prompt consideration of systemic vasculitis and urgent referral for specialist assessment NICE NG143 Nwannunu et al. 2020Chevet et al. 2023Amin et al. 2023.