Flashcards in Vasculitis Deck (39)
What is vasculitis?
Heterogeneous group of disorders that all have inflammation of the blood vessel walls in common
What is the problem with vascular damage?
It causes end organ damage
How do the vasculitides present?
With fever/myalgias/arthralgias/malaise, then organ specific signs and symptoms
Direct invasion of vessel wall by pathogens that result in inflammation.
Fungal causes of vasculitis
Bacterial causes of vasculitis
Treponema pallidum, legionella, pseudomonas.
Not known to be caused by direct invasion of the vessel wall, perhaps immune mediated. q
Why is it important to distinguish infectious/noninfectious vasculitis?
Because for noninfectious, immunosuppression could exacerbate infectious. Also know that noninfectous vasculitis can be precipitated by an infectious process.
Important vasculitis classifications
Large medium small variable vessel vasculitis
Medium vessels are...
Main visceral arteries, veins and their initial branches.
Small vessels are..
intraparenchymal arteries, arterioles, capillaries, venules, and veins
If a disease is classified as large vessel, or whatever, can it affect other vessels?
Some immunological mechanisms that can initiate non-infectious vasculitides
SLE: Dna-antiDNA complexes
Polyarteritis nodosa: HepBag and AB complexes
Streptokinase/penicillin are antigenic
Antiendothelial cell antibodies may predispose to kawasaki disease
Anti-neutrophil cytoplasmic antibody. Circulating that react with cytoplasmic antigens in neutrophils and endothelial cells. cytoplasmic anca is now Proteinase 3 anca (PR3anca). Perinuclear anca is now MPO-anca (myeloperoxidase).
Blindness in giant cell arteritis due to
Infection of small vessels ,even though GCA is a large artery disease.
Two major variants of LVV
Giant Cell Arteritis (>50)
Takayasu Arteritis (<50)
Histopathologically indistinguishable -- granulomatous
Has giant cells, epithelioid macrophages and a collar of lymphocytes
How to diagnose GCA
Temporal artery biopsy.
Does a negative biopsy rule out GCA?
No. Start steroids
Biopsy appearance for GCA
Intimal thickening with granulomatous inflammation. IEL fragmentation with elastic stain.
Where does takayasu arteritis present
Left subclavian, left common carotid, brachiocephalic artery
How to diagnose?
Can't do biopsy because of the vessels involved. Signs of limb ischemia, decreased pulse at brachial arteries, blood pressure difference between arms, subclavian bruits
Patients with Takayasu?
80-90% females. Under 40.
How to treat takayasu arteritis?
Glucocorticoids early, vascular surgery later.
Medium vessel vasculitis onset compared to LVV
Onset in more acute and necrotizing than in LVV.
Two major categories of MVV
Necrotizing vasculitis of medium to small arteries (ONLY!). Often leads to inflammatory aneurysms or rupture
Most commonly involved arteries in polyarteritis nodosa?
Renal arteries. causing hypertension and ischemic nephropathy But not glomerular capillaries. So no glomerulonephritis
What set of arteries does PAN usually spare?