R/O - Vasculitis and fibromyalgia Flashcards
takayasu arteritis classification
3/6 of:
- age under 40
- claudication of extremities
- decreased brachial artery pulse
- BP difference over 10 mm Hg between arms
- bruit over subclavian or aorta
- arteriogram abnormality: occlusion or narrowing
what is the gold standard diagnostic test for takayasu arteritis?
angiogram
classic PAN affects what sized vessels?
small and medium
wegeners granulomatosis affects what sized vessels?
small and medium
churg strauss affects what sized vessels?
small and medium
kawasaki syndrome affects what sized vessels?
small and medium
takayasu affects what sized vessels?
large
HSP affects what sized vessels?
small
cryoglobulinemia affects what sized vessels?
small
what conditions can mimic systemic vasculitis?
- atheroembolic disease
- cardiac myxoma
- thrombotic disorders (anti phospholipid antibody syndrome, TTP)
- drug induced vascular damage (ergot, cocaine, amph)
- infective endocarditis
how is PAN differentiated from polyangiitis?
PAN:
- small and medium muscular artery
- renal vascular nephropathy
- no lung involvement
- ANCA NEGATIVE
POLYANGIITIS:
- small and medium arteries, arterioles, venules, capillaries
- glomerulonephritis
- lungs involved (33%)
- ANCA POSITIVE
wrist drop is seen in what vasculitis disorder?
PAN
subcutaneous nodules in hand - which vasculitis?
PAN
what is cryoglobulinemia?
immunoglobulins that undergo reversible precipitation in the cold
what are the clinical features related to immune complex deposition in cryglobulinemia?
- purpura
- arthralgia
- nephritis
- neuropathy
wegeners granulomatosis with polyangiitis classification
2/4 of:
- nasal or oral inflammation (ulcers, bloody nasal drainage)
- abnormal chest radiograph (nodules, fixed infiltrates, cavities)
- urinary sediment
- granulomatous inflammation on biopsy (wall of artery or arteriole, perivascular, or extravascular)
polymyalgia rheumatica: clinical features
- pelvic and shoulder girdle aching
- morning stiffness
- rapid response to low doses of corticosteroids**
- anemia
polymyalgia rheumatica: lab features
- anemia
- elevated ESR and CRP
giant cell arteritis: lab features
- elevated ESR
- elevated CRP
- anemia
- elevated alk phos
what is the first manifestation of giant cell arteritis?
PMR symptoms
definition: fibromyalgia
chronic pain disorder with unknown etiology and unclear pathophysiology
what is the (proposed) pathogenesis of fibromyalgia?
- temporal and spatial pain summation
- decreased endogenous pain inhibition
- unique to temporal brain activation of frontal cortex, motor cortex, and cingulate cortex in anticipation of pain
- significant reduction in total gray matter volume suggesting premature aging
- higher levels of glutamine in right posterior insula
what are the clinical manifestations of fibromyalgia?
- widespread musculoskeletal pain
- paresthesias
- fatigue
- cognitive and mood disturbances
- depression and/or anxiety
- headache
