Overview
Diagnosis
There is no single test to diagnose eosinophilic granulomatosis with polyangiitis (EGPA). Healthcare professionals usually rely on a combination of tests to check for inflammation, elevated eosinophil levels, and organ involvement.
Common diagnostic steps include:
• Blood tests – These can detect antibodies that may suggest, but not confirm, EGPA. Blood tests also measure eosinophil levels. High eosinophils can support an EGPA diagnosis but can also appear in other conditions such as asthma.
• Imaging tests – X-rays, CT scans, or MRI scans can show inflammation or damage in the lungs and sinuses. If heart problems are suspected, an echocardiogram may be done to check heart function.
• Tissue biopsy – When other results suggest EGPA, a small tissue sample may be taken from the lungs, skin, or another affected organ. The biopsy is examined under a microscope to look for inflamed blood vessels, called vasculitis, which helps confirm the diagnosis.
Your healthcare team also reviews your medical history, symptoms, and how your body responds to treatment before confirming EGPA.
Treatment
Although there is no cure for EGPA, treatment focuses on reducing inflammation, controlling symptoms, and preventing long-term complications.
Corticosteroids
The primary treatment is prednisone, a corticosteroid that quickly reduces inflammation. Treatment usually starts with a higher dose that is gradually lowered once symptoms improve. Long-term or high-dose use of corticosteroids can cause side effects such as:
• Weight gain
• High blood sugar or diabetes
• Cataracts
• Increased infection risk
• Bone loss (osteoporosis)
Your healthcare team monitors these risks closely and may suggest ways to prevent complications.
Other medicines that suppress the immune system
For people with severe symptoms or poor response to steroids, additional immune-suppressing medicines may be needed. These include:
• Mepolizumab (Nucala) or benralizumab (Fasenra) – the only FDA-approved treatments for EGPA that specifically target eosinophils.
• Azathioprine (Azasan, Imuran)
• Cyclophosphamide (Cytoxan)
• Methotrexate (Trexall)
• Rituximab (Rituxan)
Because these medicines can weaken the immune system, regular monitoring is important to prevent infections and side effects.
The goal of treatment is to control inflammation, prevent flare-ups, and protect organs from lasting damage.
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