Rheumatic immune diseases are one of the most complex groups of diseases in the internal medicine system, and the diseases belonging to them are mainly characterized by multi-organ and multi-system involvement, which is different from the damage to single organs such as respiratory, circulatory, digestive, and neurological systems, and non-specific clinical manifestations such as fever, rash, tiredness, and weight loss, which inevitably baffle young or non-specialized doctors. This group of diseases is difficult to obtain pathology, imaging examination specificity is not strong, so it is difficult to confirm the diagnosis from the pathological level, imaging level, and for the diagnosis of relatively specific autoantibodies, non-specialized doctors can not interpret its clinical significance, and it is difficult for young doctors to do with the clinical corroboration of each other, in short, the diagnosis of this group of diseases feels like nothing to start with. Rheumatic diseases and primary systemic necrotizing vasculitis is the most difficult of the difficult, large vessel vasculitis is quite easy, it is only the bifurcation of stenosis / occlusion of blood vessels, the distal blood supply is insufficient, according to the map to find the way, a comprehensive imaging examination is difficult to miss the diagnosis. The top difficulty is small vessel vasculitis, which has a very low incidence, is invisible, cannot be felt, and has more nonspecific symptoms. Frequently lung and kidney are involved, where diffuse interstitial lung lesions, acute alveolar hemorrhage, and rapid progressive nephritis (RPGN) are difficult to detect early. Confirmation of the diagnosis is difficult, need renal puncture, but often miss the best time, and the patient mostly refused, good thing there is ANCA corroboration, but many doctors do not know its clinical significance, many hospitals have not yet carried out the program.1994 CHCC according to the caliber of the blood vessel classification, divided into large, medium and small vasculitis, it seems to be very well grasped, the surface is very rich, the reality is too bony, there are n number of diseases are not included, from time to time, by the expert In 2012, the CHCC reclassified the classification, and the part of small vasculitis was changed the most. 2009, when I first went to Japan for further training, the training program was vasculitis diagnosis and treatment. However, when I talked to my supervising professor, Prof. Suhara of the Department of Hematology and Rheumatology at Yamaguchi Prefectural General Medical Center, he expressed his regret that he could not teach Mr. Wang much. However, according to the information I have, the Japanese rheumatology community’s level of research on this type of disease is undoubtedly much higher than ours, and although they have very few patients, basically all of them are registered without any omission, because they belong to the country’s specific categories of difficult diseases, and patients do not have to pay for the diagnosis of the diagnosis and treatment themselves. The Ministry of Health, Labour and Welfare (the Ministry of Health) takes the lead in organizing research classes from time to time, and the class leaders lead the nation’s experts in discussions, and after reaching a consensus, they release it in the form of a national guideline for the academic community. As for basic research, it is also at the forefront of the world due to its strong economy and huge investment, as exemplified by IgG4-related diseases. The most common clinical manifestations of vasculitis can be summarized as: lungs, kidneys, skin, and nerves. In the presence of involvement of two or more of these systems, vasculitis should be suspected and relevant investigations should be performed. In large and medium-sized vasculitis, angiography is the main diagnostic tool, and in small-sized vasculitis, autoantibodies including ANCA should be examined, so that when abnormalities are detected, the patient should consult a specialized doctor in a timely manner.