Lecture 11: Vasculitis Flashcards
- Large vessel vasculitis means it involves the () and () vessels.
- Medium vessel vasculitis means it involves the () vessels
- Small vessel vasculitis means it involves the (), () and () to lungs, kidneys, and skin
- Large vessel = aorta and great vessels
- Medium vessel = splanchnic vessels (kidney/abd)
- Small vessel = capillaries, arterioles, and venules
Both polymyalgia rheumatica and temporal arteritis share preference for the same () haplotype and both MC occur after the age of ()
- Same HLA haplotype.
- Both occur after 50 usually.
Also can frequently occur together.
T/F: Polymyalgia rheumatica typically occurs with temporal arteritis.
False. It MC begins as polymyalgia rheumatica isolated and later develops temporal arteritis
Your patient has trouble combing their hair, putting on a coat, and difficulty rising out of a chair. It hurts and is stiff! There’s no swelling and their temporal artery looks fine. You suspect they have…
Polymyalgia rheumatica
T/F: ESR and CRP are elevated in polymyalgia rheumatica
True
The first-line tx for Isolated polymyalgia rheumatica is…
Prednisone daily over 2-4 weeks with a slow taper.
Can also add weekly MTX while using.
Usually an annual thing.
We use (ESR/CRP) to monitor progress of isolated polymyalgia rheumatica.
ESR
A 79+ year old scandinavian women with HLA-DR4 describes the classic demographic for what vasculitis?
GCA/Temporal arteritis
Although the temporal artery is the MC carotid branch affected in GCA, it can also spread to…
The aorta and its branches
What layer of a blood vessel is GCA/temporal arteritis suspected to begin within?
Adventitia
You have a 60F presenting with headache, scalp tenderness, and intermittent amaurosis fugax. She also notes jaw claudication. You believe she has (vasculitis), and you should be concerned for what organ system specifically?
- GCA/temporal arteritis
- Concerned for her VISION!!!
T/F: Temporal artery thickening/nodularity is the typical finding on PE for GCA.
False. Normally its just normal
Temporal arteritis is associated with:
- ESR ()
- (MCHC), (MCV) anemia
- Serum CK ()
- Elevated ESR (> 50 to > 100)
- Normochromic, normocytic anemia
- Serum CK is NORMAL
The standard of diagnosis for GCA is…
Temporal artery biopsy
T/F: Blindness is GCA once it occurs is usually reversible.
False. Once you turn blind blind in GCA, you’re done :(
The first-line pharm tx for non-visual loss GCA is…
High dose prednisone for 1 month
Can add tocilizumab to reduce prednisone use.
Tx of GCA w/ visual loss is…
IV methylprednisolone
Monitor via ESR.
Your patient being treated for GCA is starting to show symptoms of hyperglycemia and HTN. You suspect that this is due to…
Steroid toxicity
Also can induce psychosis
GCA greatly increases the risk of a () aneurysm
Thoracic aortic aneurysm
Polymyalgia vs GCA
I feel like jaw claudication and vision are the biggest things for GCA. Its the more severe disease.
() infection is seen in 10% of patients with Polyarteritis Nodosa
Hep B
Polyarteritis Nodosa (PAN) primarily affects the (organ) and () arteries, causing necrotizing arteritis.
Renal and visceral arteries