OnlineMedEd - Rheumatology: Vasculitis

Question 1

What three arteries are most commonly affected in giant cell arteritis?

Answer 1

• Ophthalmic
• External carotid
• Temporal (which is a branch of the external carotid)

Question 2

Patients with giant cell arteritis present with what symptoms?

Answer 2

• Jaw claudication and temporal tenderness (temporal artery effects)
• Vision changes (ophthalmic artery effects)

Question 3

How is giant cell arteritis diagnosed?

Answer 3

With biopsy, although if you see vision changes, jaw claudication, and temporal tenderness you should skip the biopsy and treat with steroids

Question 4

Summarize Takayasu.

Answer 4

• Large vessel arteritis
• Affects the aortic arch and immediate branches (e.g., subclavian artery)
• Presents in young women (less than 40)
• Often shows extremely weak or imperceptible pulses on exam

Question 5

How can Takayasu be definitively diagnosed?

Answer 5

With an angiogram

Question 6

Run through Kawasaki syndrome.

Answer 6

Remember the CRASH and Burn mnemonic: 
•Conjunctivitis
•Rash 
•Adenopathy 
•Strawberry tongue
•Hand and foot edema, erythema, and desquamation
•Burn = fever for 5 days or more

Question 7

How is Kawasaki syndrome treated?

Answer 7

IVIG and aspirin

Question 8

What organ systems does polyarteritis nodosa target?

Answer 8

• Gut (leading to mesenteric ischemia)
• Skin
• Renal (leading to renal failure)

Question 9

Which vasculitis disorder presents with neural symptoms?

Answer 9

Polyarteritis nodosa (which can cause mononeuritis multiplex: an asymmetric loss of motor and sensory function)

Question 10

Polyarteritis nodosa is associated with ______________.

Answer 10

hepatitis B

Examiners like you to know that treatment of HBV typically improves the course of PAN.

Question 11

How can polyarteritis nodosa be definitively diagnosed?

Answer 11

Angiogram showing aneurysms in medium-sized vessels

Question 12

Polyarteritis nodosa is treated with ________________.

Answer 12

steroids and cyclophosphamide

Question 13

The new term for Wegener’s is _________________.

Answer 13

granulomatosis with polyangiitis

Question 14

GPA typically presents with ________________.

Answer 14

hemoptysis, hematuria, and sinus erosions/ulcers/damage

Question 15

How is GPA treated?

Answer 15

Steroids and cyclophosphamide (for aggressive cases)

Question 16

Microscopic polyangiitis is essentially ________________.

Answer 16

Wegener’s with pANCA

Question 17

Churgg-Strauss is essentially ______________.

Answer 17

pANCA with eosinophilia

Question 18

What is cryoglobulinemia?

Answer 18

A hepatitis C immune complex vasculitis that affects the small vessels. It presents with purpura and low complement.

Question 19

How can cryoglobulinemia be treated?

Answer 19

• Plasmapheresis
• Steroids or cyclophosphamide
• Treat the HCV

Question 20

Henoch-Schonlein purpura can be definitively diagnosed with ________________.

Answer 20

biopsy of the purpura

Question 21

Cyclophosphamide can be used for which of the vasculitides?

Answer 21

Small and medium (i.e., not GCA or Takayasu)