Vasculitis Flashcards
Anti-neutrophil cytoplasmic antibodies (ANCA) are associated with what small vessel vasculitides?
- Granulomatosis with polyangitis (Wegener’s polyangitis)
- Eosinophilic granulomatossis with polyangitis (Churg-Strauss)
- Microscopic polyangitis
What are the common findings of ANCA associated vasculitides?
- Renal impairment (immune complex glomerulonephritis –> raised creatinine, haematuria, proteinuria)
- Resp symptoms: dyspnoea, haemoptysis
- Systemic symptoms: fatigue, weight loss, fever
- Vasculitic rash (only present in minority)
- Sinusitis
What investigations are carried out for ANCA associated vasculitides?
- Urinalysis (haematuria and proteinuria)
- Bloods
- X-ray
What bloods are done to investigate ANCA associated vasculitides (and why)?
- Urea and creatine (renal impairment)
- FBC (normocytic anaemia with thrombocytosis may be seen)
- CRP (raised)
- ANCA testing
What may be seen on X-ray for ANCA associated vasculitides?
Nodular, fibrotic or infiltrative lesions
What are the 2 types of ANCA and which vasculitides are associated with each?
- cANCA: granulomatosis with polyangitis (Wegener’s), microscopic polyangitis (40%)
- pANCA: eosinophilic granulomatosis with polyangitis (Churg-Strauss), microscopic polyangitis (75%)
What other conditions are associated with pANCA?
- Ulcerative colitis (70%)
- Primary sclerosis cholangitis (70%)
- Anti-GBM disease (25%)
- Crohn’s (20%)
Does cANCA or pANCA have association with disease activity (and can therefore be used for monitoring?
cANCA
How are ANCA associated vasculitides managed?
- Once suspected, refer to specialist teams
- Kidney or lung biopsy may be required
- Mainstay of treatment is immunosuppression
What clinical features can differentiate between Wegener’s and Churg-Strauss
Churg-Strauss will present with eosoniphila and features of asthma
