RHEUM: vasculitis

Question 2

What is vasculitis ? How is this big group of conditions divided?

Answer 2

Inflammation of blood vessels.

Divided based on whether they affect :
Small vessels
Medium vessels
Large vessels

Question 3

What are some examples of Small vessel vasculitis?

Answer 3

Microscopic polyangitis (MPA)

Granulomatosis with polyangitis (GPA): resp + kidneys+cANCA

Eosinophillic granulomatosis with polyangitis: assoicated with asthma + eosinophils +pANCA

IgA vasculitis

Question 4

What are some examples of medium vessel vasculitis?

Answer 4

Kawasaki disease (KD)
Polyarteritis nodsa (PAN)

Question 5

What are some examples of large vessel vasculitis?

Answer 5

Giant cell arteritis (GCA) 
Takayasu arteritis (TAK)

Question 6

what can cause Secondary vasculitis? (mimics vasculitis )

Answer 6

Drugs
Infection
malignancy
connective tissue disorder

Question 7

General Presentation of Vasculitis - features that most types share

Answer 7

Purpura (leaking blood vessels)
joint and muscle pain 
peripheral neuropathy 
ask about Raynaud's
Renal impairment h
GI disturbance (Abdo pain, PR bleeeding, diarrhoea)
Anterior uveitis and scleritis 
Hypertension

Systemic :
Fatigue
fever
weight loss
anorexia 
weight loss

Question 8

Investigations for Vasculitis

Answer 8

ALERT
Renal involvement - urine dipstick +/- microscopy - glomerulonephritis

Bloods:
FBC, U&Es, LFts, PV, CRP, ESR

serum antibodies :
ANCA - anti neutrophil cytoplasmic antibodies test for vasculitis - p-ANCA and c-ANCA
ANA
RF

p33 of rheum workbook has lots more detail of other tests

Question 9

Management of Vasculitis?

Answer 9

Depends on type - see pg 234 of Z2F for details.

General :
Rule out infection
stop offending drug e.g. secondary cause

1st line : Corticosteroids for target area
e.g. oral prednisolone/ IV hydrocortisone/ nasal/ inhaled

2nd line: Cyclophosphamide
Methotrexate
Azathioprine
rituximab

Question 10

______(1)_____ is a common cause of skin vasculitis due to medication

_____(2)______ can present with vasculitis like syndrome. ECHO will exclude

Answer 10

_____Hypersensitivity vasculitis_____ is a common cause of skin vasculitis due to medication

_____Atrial myxoma (tumour)______ can present with vasculitis like syndrome. ECHO will exclude

Question 11

What is the difference between GCA and trigeminal neuralgia?

Answer 11

GCA- chronic vasculitis of large and medium sized vessels in the head whereas TRIGEMINAL NEURALGIA- compression of trigeminal nerve

GCA- presents with headaches, stabbing facial pain and visual disturbances
TRIGEMINAL NEURALGIA- electric shock and knife pain unilaterally