Anca Positive Vasculitis And Pauci Immune RPGN

Question 1

Which has higher risk relapse? WG OR MPA

Answer 1

Wegners

Question 2

Induction?

Answer 2

Cyclophosphamide

Pulse as good as oral and possibly less toxicity

Question 3

Maintenance?

Answer 3

AZA as good as cyclo and less toxicity

AZA also better than MMF

Usual is cyclophosphamide 3 months then AZA two years

Question 4

Relapse?

Answer 4

Rituximab non inferior to cyclo in induction
Rituximab better than cyclo in relapse disease

RAVE ITN trial nejm

Most often use rituximab if have already had cyclo

Question 5

Indications for plasma exchange in Wegners

Answer 5

Severe Renal failure
Concurrent anti GBM disease
Pulmonary haemorrhage

Note BAD to use in lupus nephritis as per trials