Vasculitis

Question 1

How to classify vasculitis?

Answer 1

1. Large vessel vasculitis
2. Middle vessel vasculitis
3. Small vessel vasculitis
   Subtype a: Immune complex
   Subtype b: ANCA-associated

Primary vasculitis has no known cause

Question 2

Common features of all vasculitis?

Answer 2

fever, malaise, weight loss and fatigue

Question 3

What are the common organ manifestations of Takayasus arteritis (a subtype of large vessel vasculitis)? How to diagnose?

Answer 3

Typically for females under 40y/o
- Claudication in arms
- Blood pressure difference of extremities or absent pulse
- Hear bruit, with the most common location being the carotid artery

CT angiogram
Bloods also show inflammatory response

Question 4

What are the common organ manifestations of giant cell arteritis (a subtype of large vessel vasculitis)? How to diagnose?

Answer 4

Typically for those over 50 y/o

Unilateral acute temporal headache
Scalp tenderness
Temporary visual disturbances
Jaw claudication

Strong association with polymyalgia rheumatica

*Blood inflammatory markers
*US - great investigation, but sensitivity not so good
*Temporal artery biopsy (skip lesions may result in false negative biopsy)
*PET scan (the better one) or CT angiogram can be useful when there are no cranial symptoms

Question 5

How to treat large-cell vasculitis?

Answer 5

1. Start 40-60mg prednisolone.
2. Steroid sparing agents given in TA and may be considered in GCA. e.g. Leflunamide, methotrexate

Question 6

What are the common organ manifestations of polyarteritis nodosa(a subtype of middle vessel vasculitis)? How to diagnose?

Answer 6

Typically beyond middle age
Can be primary/secondary (associated with hepatitis B C)

*Renal – most commonly involved, hypertension, renal function impairment
*Skin – Purpura, livido reticularis, ulcers
*Musculoskeletal- muscle pain
*Neurological – mononeuritis, polyneuropathy
*GI – abdominal pain, diarrhea with or without blood, bowel perforation

Biopsy
Angiogram

Question 7

How to treat polyarteritis nodosa?

Answer 7

Treatment in organ-threatening disease – steroids + Cyclophosphamamide

Treatment of NON-organ-threatening disease – steroids + Azathioprine/methotrexate/mycophenolate

Question 8

What are the common organ manifestations of all types of small vessel vasculitis?

Answer 8

Many!

Question 9

Differences between ANCA-associated subtypes (Anti-Neutrophilic Cytoplasmic Autoantibodies) of small vessel vasculitis?

Answer 9

Question 10

What are initial and further tests for small vessel vasculitis?