Flashcards in Vasculitis Deck (28):
How can vasculitis be classified?
Into the vessel size affected- small, medium and large
What are the small vasculitis?
Granulomatous with polyangitis
Henloch Scholein Purpura
What are the medium cell vasculits?
What are the large vessel vasculitis?
GCA and Takayasu
How can small vessel vasculitis be further split?
ANCA associated - microscopic polyangitis, Wergeners and Churg strauss
Immunological associated - Goodpastures disease, IgA vasculitis
What is the general management for vascultiis?
Large - steriods
Medium and small - immunosuppression
What is polyarteritis nodosa?
Necrotsing vasculitis that causes aneurysms and thrombosis in medium size vessels leading to infarct of organs affected and severe systemic symptoms
Appears like beads on a string
Can be secondary to HBV
What are the symptoms of polyarteritis nodosa?
Skin - punched out ulcers, nodules
Renal - main cause of death - renal artery narrowing, glomerular ischaemia and HTN
Cardiac, GI and GU invovlement
Usually spares the lungs
How does Wergeners disease present?
Affects the nasopharynx, lung and kidney
> rapidly progressing cresenteric glomerulonephritis
Biopsy shows inflammation and granulamas in vessel wall
How is Wergeners treated?
Corticosteriods and cyclophosphamide
How does Churg Strauss present?
pANCA - sinusitis, lung, kidney, GI, skin, nerve and heart damage
What is the pathophysiology behind HSP?
IgA deposition against endothelial cells
Buttock and thigh purpura
Where does microscopic polyangitis affect?
Lungs and Kidney
What is Kawaski disease?
Vasculitis of the coronary arteries which can lead to aneurysms and ischaemia of the coronary tissue
What should be done in a patient with suspected Kawaski disease?
Aspirin and Ig IV
What are the features for diagnosis of Kawaski disease?
Swollen hands and feet
Plus fever for more than five days
What is Beurgers disease?
Clots in fingers and toes --> ulcer --> auto amputation
What is GCA?
Inflammation of the branches of the carotid arteries. Usually the temporal artery
How does GCA present?
Headaches, scalp tenderness, jaw claudication, systemic symptoms
May have vision changes including Amaurosis fugax
What are the investigations done in GCA?
ESR will be greatly raised and urgent referral for biopsy
What is the treatment for GCA?
Prednisolone 40mg per day
60mg if visual changes
*will be on long term steriods so think about bone and GI protection*
What is affected in Takayasu arteritis?
Aortic arch branches - can lead to pulselessness and neuro/visual symptoms
Long term complications include limb ischaemia and renal failure
what is the management of Takayasu disease?
What are the three main features of polyarteritis nodosa?
Aneursym, thrombosis and infarct
In all vasculitis what should be done?
Urine dip to look for signs of haematuria and proteinuria
What may be found on examination in a patient with Takyasu?
vascular bruits may be audible over the carotids, abdominal aorta, or subclavian vessels. Unequal blood pressures may be recorded between sides, and a murmur of aortic regurgitation may be heard if there is aortic root dilation.
How is remission maintained in a patient with granulomatosis with polyangitis ?
Remission can be maintained using low-dose corticosteroids and either azathioprine or methotrexate.