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Q

Ongoing management of ANCA+ Vasculitis

A

Goals:

  • Monitor disease activity & maintain remission
  • Prevent complications

Confirm dx

  • ANCA, tissue biopsies

Monitor disease activity & treating exacerbation

  • Ix - 3 monthly
    • History & exam - respiratory symptoms, neuropathy, rash
      • Best as ANCA is controversial, ESR/CRP are non-specific
    • MPA/GPA: ANCA titre, ESR, CRP, EUCs, UA
    • EGPA: above + Eosinophils
    • Organ-specific: e.g. CT chest, PFT, TTE
    • Tissue biopsy
  • Mx
    • Induction: steroids (1mg/kg) + rituximab or cyclophosphamide
    • Maintenance: rituximab, AZA, MTX, MMF

Monitor for complications (cardiovascular, ImmSx, steroids)

  • Ix: 3 monthly FBC (cyclophosphamide, MTX), LFTs, lipids, HBA1C, DEXA (steroids), VitD/Ca/PTH (steroids). Ig levels.
  • Mx:
    • CV risk factor Mx
    • Vaccination
    • Infection Prophylaxis (e.g. Bactrim)
    • Malignancy screening
    • Fertility (cyclophosphamide)