Flashcards in Vasculitis Deck (49)
What are some symptoms common to vasculitis?
- palpable purpura (non-blanching)
- livedo reticularis (due to dilation of blood vessels)
VERY variable however
What would a blanching lesion indicate?
blood vessel swelling because you can physically push the blood out
What are the two major cause of vasculitis?
- immune mediated inflammation (most)
- direction invasion of vascular walls by infectious pathogens
What else can infections do?
cause a noninfectious vasculitis, by generating immune complexes or triggering a cross-reactive immune response
Immunologic injury in non-infectious vasculitis may be caused by:
- immune complex deposition
- anti-neutrophil antibodies (ANCA)
- antiendothelial cell antibodies
- autoreactive T cells
What are some vasculitis' that affect large vessels (aorta and its primary branches)?
- temporal (giant cell) arteritis
- Takayasu arteritis
What are some vasculitis' that affect medium vessels (muscular arteries and supply organs)?
- Polyarteritis nodosa
- Kawasaki Disease
- Buerger disease
What are some vasculitis' that affect small vessels (arterioles, capillaries, and venules)?
- Wegener's Granulomatosis
- Mircoscopic polynagiitis
- Churg-strauss syndrome
- Behcet disease
- Henoch-Scholein purpura
How do temporal arteritis (TA) patients present?
- older (50+), white females
- jaw pain when they chew
- ESR often elevated over 100
What is the etiology of TA?
T cell mediated
What is the treatment for TA?
What is the major complication of TA?
blindness- there is patchy ophthalmic artery involvement. Thus, treatment is started before diagnosis usually
What happens in TA?
- intima thickening, - inflammation of ALL 3 layers of the vessel
Half of patients with TA also have what?
What is polymyalgia rheumatica?
- proximal muscle aches and stiffness
- elevated ESR
- rapid resolution of symptoms with low-dose corticosteroid therapy
What is Takayasu arteritis?
granulomatous vasculitis (like TA- hist looks exactly the same) that classical involves the aortic arch at branch points and is common adults LESS than 50 y/o (primarily young, female Asians)
How do Takayasu arteritis patients present?
-younger than 50 yo
-visual and neurologic symptoms with weak/absent upper extremity pulse
Treatment for Takayasu arteritis?
-prognosis isn't that good
How does Polyarteritis nods (PAN) present?
-systemic inflammation, not localized
What organ is especially targeted by PAN?
renal involvement is the major cause of death
PAN is fatal unless treated with immunosuppression
PAN is associated with what?
strong association with hepatitis B
How can you differentiate PAN from Wegener's?
in PAN, the lungs are essentially never affected
How does PAN appear histo wise?
-segmental transmural necrotizing inflammation of small to medium sized arteries (can lead to aneurysm)
-fibrinoid necrosis is common
How does Kawasaki disease present?
-affects mostly Asian kids
-CRASH and burn:
Hand or feet changes/swelling/desquamation,
burn (fever 5+ days)
What does untreated Kawasaki disease lead to?
coronary aneurysm and MI
Treatment for Kawasaki disease?
-Aspirin (the only time you give aspirin)
Mircoscopically Kawasaki disease resembles what?
What is thromboangiitis Obliterates (Buerger Disease)?
a disease of younger smokers that causes inflammation and thrombosis of the arteries supplying the hands and feet, leading to claudication, cold sensitivity, ischemic pain, and eventually gangrene with autoamputation of digits
What is the treatment for Buerger disease?
cessation of smoking