Vasculitis

Question 1

What is vasculitis?

Answer 1

Inflammation of BVs

Question 2

What are the 3 vessels it affects?

Answer 2

Large vessel
Medium vessel (musc arteries to organs)
Small vessel (arterioles, venules, capillaries)

Question 3

What are the diseases which affect large vessels called?

Answer 3

*GCA (Giant cell arteritis) (temporal arteritis)
Takayatsu

Question 4

What are the diseases which affect Medium vessels called?

Answer 4

*Polyarteritis Nodosa
Buergers disease
Kawasaki disease

Question 5

What are the diseases which affect small vessels called?

Answer 5

Granulomatosis with polyangitis (GPA) - ‘Wegener disease’

Eosinophilic granulomatosis with polyangitis (EGPA)

Heuloch Schonlein Purpura

Question 6

General Tx for Vasculitis?

Answer 6

Corticosteroids

Question 7

What should you consider when steroids given long term?

Answer 7

GI + Bone protection
PPI + Bisphosphonates

Question 8

GCA
Who does it affect?

Answer 8

50+, caucasian

Question 9

Sx of GCA?

Answer 9

Unilateral temporal headache, jaw claudication +/- vision change
Scalp tenderness

Question 10

Pathology of GCA

Answer 10

Affects branches of external carotid
Scalp tenderness = temporal branch
Vision = opthalmic branch
Jaw = facial branch

Question 11

Dx of GCA?

Answer 11

High ESR +/- CRP (1st line)
Temporal artery biopsy
Diagnostic = granulomatous inflammation of media and intima
Patchy skip lesions therefore take big chunk

Question 12

Treatment for GCA?

Answer 12

Corticosteroids (prednisolone)

Question 13

What is a complication of GCA?

Answer 13

Sudden painless vision loss in one eye (optic neuropathy)

Question 14

Is it temporary or permanent?
Treatment?

Answer 14

Temporary = Amaurosis fugax (loss in 1 or both eyes) - seen in TIA
May be permanent if not dealt with ASAP
High dose IV methylprednisolone

Question 15

Takayatsu
Who does it affect?
What part of artery does it affect?
Otherwise same as?

Answer 15

Asian/japanese women
mainly affects aortic arch
otherwise same as GCA

Question 16

Buergers disease
Who does it affect?
Sx?

Kawasaki Disease
In who?
Causes?

Answer 16

Male smokers 20-40
peripheral skin necrosis - thromboangitis obliterates - clots in arteries of fingers and toes

Children, Causes coronary artery aneurysms

Question 17

Polyarteritis Nodosa
Who is affected?
Associated with?
Which layers of the artery are affected?

Answer 17

Males
Associated with Hep B
Inflammation in all 3 vessel wall layers

Question 18

Polyarteritis Nodosa Sx?

Answer 18

Severe Systemic Sx
Mononeuritis multiplex (ischemia of vasa nervosum)
GI bleeds (mesenteric artery)
CKD/AKI (renal artery - causes pre renal AKI)
Skin SC nodules + haemorrhage

Question 19

Diagnosis of Polyarteritis Nodosa

Answer 19

CT angio = needs on string (micro aneurysms)
Biopsy (eg. kidney) - Necrotising vasculitis due to htn

Question 20

Tx for polyarteritis Nodosa

Answer 20

corticosteroids
Control htn - ACE I
Hep B Tx after corticosteroids

Question 21

Granulomatosis with polyangitis
It is a cause of?
+ve for?

Answer 21

A cause of glomerulonephritis (+pul Sx)
Saddle shaped nose
cANCA +ve
‘Wegener disease’

Question 22

Eosinophilic granulomatous with polyangitis
What Is +ve?

Answer 22

‘churg strauss’ disease
pANCA +VE

Question 23

Heuloch Schonlein Purpura
High what?

Answer 23

High IgA
IgA vasculitis as a DDx for IgA nephropathy
Both present as IgA deposition in GBM on kidney biopsy but HSP has purpuric rash on shins + affects other organs (joints/abdo/renal)