The systemic vasculitides are a group of uncommon but serious multisystem autoimmune disorders characterized by blood vessel inflammation. Timely diagnosis and intervention are crucial in preserving organ function and reducing mortality and morbidity. Immunosuppressive agents are the cornerstone of treatment and have revolutionized outcomes. Nevertheless, disease relapse is common and individuals with vasculitides accumulate significant risks of infection, cardiovascular disease and malignancy over time compared with the general population. Toxicity from therapeutic agents – especially glucocorticoids – contributes to these complications.