Vasculitis

Question 1

Define Vasculitis.

Answer 1

inflammation and destruction of the blood vessel walls leading to impaired blood flow.

• Split into Large, Medium and Small vessel vasculitis.
• Small vessel is split into ANCA +ve and ANCA -ve

Question 2

Give examples of the different types of vaculitis:
Large vessel?
Medium vessel?
anca +ve small vessel?
anca -ve small vessel?

Answer 2

large = GCA, takayasu’s (temporal and arota)
Medium = polyarteritis nodosa (renal and heart) and kawasaki’s (<5s)
ANCA +ve = wegner’s, churg-struass, microscopic polyangitis (ALL AFFECT LUNG AND KIDNEY)
ANCA -ve = Henoch-Schonlein purpura

Question 3

clinical presentation of vasculitis?

Answer 3

DEPENDS ON VESSELS AFFECTED

Question 4

Tell me more about Giant Cell Arteritis:
Vessels affected?
associated condition?
Importance?
Symptoms?
investigations?
Treatment?

Answer 4

• Affected vessels = temporal, aorta, extra-cranial branches of carotid
• associated with Polymyalgia Rheumatica
• CAN GO PERMANENTLY BLIND IF UNPROMPTED TX
• <1 month onset, headaches, scalp tenderness, jaw claudication, visual disturbances, Sx of polymyalgia rheumatica
• Ix - temporal artery biopsy, ESR >50, age >50, pulseless temporal artery, new onset headache
• GIVE ORAL PRED IMMEDIATELY biopsy later - High Dose preed 48hrs = should be good repsonse OR wrong diagnosis
• URGENT ophthalmology r/v

Question 5

Tell me more about Wegner’s granulomatous?

Answer 5

• preferred name = granulomatosis with polyangiitis
• anca +ve small vessel vasculitis
• affected URT, lungs and kidneys
• raised ESR and CRP
• take renal biopsy
• CXR for lung involvement

Question 6

Sx of granulomatosis with polyangitis?

Answer 6

FUCKS EVERYWHERE

• URT - sinusitis, otisis, saddle shape nose deformity
• Lungs - nodules, haemoptysis, dyspnoea
• kidney - rapidly progressive glomerulonephritis
• CNS - MMX, CN lesions
• all sorts of eye shit
• skin - purpuric/vasculitis rash
• GU/GI sx, pericarditis, synovitis

Question 7

Tx for granulomatosis with polyangitis?

Answer 7

• severe disease - high dose steroids + immunosuppressant drugs (cyclophosphamide)
• non-end organ damage less heavy shit - MTX, mycophenolate, azathioprine
• plasma exchange
• biologics - rituximab

Question 8

HSP tell me?

Answer 8

HSP

• IgA immune complexes deposited about
• seen mainly in children
• palpabe purpuric rash on legs and buttocks
• abdo pain, arthritis, nephritis/haematuria
• kidney biopsy - diagnosis
• usually preceded by an URTI
• spontaneous resolution