Rheum - MedEd - vasculitis

Question 1

How to divide the different vasculitides?

Answer 1

Small, medium, large vessel

Question 2

Large vessel vasculitides - types?

Answer 2

Giant cell arteritis

Takayasu

Question 3

Giant cell arteritis effects which arteries?

Answer 3

External carotid
Opthal
Temporal (sometimes called temporal arteritis)

Question 4

GCA - presents with…

Answer 4

Jaw claudication
Amaurosis fugax - vision changes
Temporal tenderness - temple is tender in headache
-Usually age >50
*If presents with these symptoms… treat with steroids even before getting the biopsy

Question 5

How to diagnose GCA

Answer 5

Biopsy - granulomas

Question 6

Takayasu involves with arteries

Answer 6

Aorta and branches (subclavian and femoral)

Question 7

Takayasu arteritis presents with (population and symptoms)

Answer 7

Young woman <40

Pulselessness - radial, brachial, femoral not palpable

Question 8

Diagnosis of Takayasu by…

Answer 8

Angiogram

Question 9

Treatment of Takayasu

Answer 9

Steroids

Question 10

Two types of medium artery vasculitides…

Answer 10

Polyarteritis nodosum

Kawasaki (pediatric, asian child, rash on palms and soles and have MI)

Question 11

Treatment of Kawasaki

Answer 11

IVIG and aspirin

Question 12

Polyarteritis nodosum (PAN) - associated with what disease in 10%

Answer 12

Hep B

Question 13

Arteries associated with polyarteritis nodosum

Answer 13

Skin, gut, renal - all over the place, so not aorta and not large vessel. This is a medium vessel disease

Question 14

Presentation of polyarteritis nodosum

Answer 14

Mesenteric ischemia
Renal failure
Purpura
Mononeuritis multiplex - motor and sensory deficit in peripheral nerve that comes and goes, painful, asymmetric

Question 15

Polyarteritis nodosum

Answer 15

Angiogram - see aneurysms

Question 16

Treatment of polyarteritis nodosum

Answer 16

Steroids + cyclophosphamide (because PAN is fatal)

Question 17

Small vessel vasculitis

Answer 17

ANCA associated

Immune complex related

Question 18

What is an ANCA-associated small-vessel vasculitides?

Answer 18

Wegener’s

Question 19

What is Wegener’s

Answer 19

Granulomatosis with polyangitis

Question 20

What are the 3 symptoms associated with Wegener’s

Answer 20

Hematuria, hemoptysis, something in the nose

Question 21

Diagnosis of Wegener’s

Answer 21

c-ANCA

biopsy - usually lung

Question 22

Treatment of Wegener’s

Answer 22

Steroids and cyclophosphamide if fatal

Question 23

ANCA type diseases… there are 3

Answer 23

Wegener’s
Eosinophilic granulomatosis
Microscopic polyangitis

Question 24

Wegener’s and microscopic polyangitis are same except one thing…

Answer 24

pANCA, not cANCA

Question 25

Wegener’s and osinophilic granulomatosis are same except one thing…

Answer 25

pANCA and eosinophilia, not cANCA

Question 26

What are the two types of immune complex disease (small vessel)

Answer 26

1. cryoglobulinemia

2. Henoch scholein purpura

Question 27

What type of cryoglobulins are associated with cryoglobulinemia?

Answer 27

Hep C

Question 28

Presentation of cryoglobulinemia?

Answer 28

Palpable purpura + Hep C

Question 29

Diagnosis of cryoglobulinemia

Answer 29

Check for cryoglobulins

Might see decreased complement

Question 30

Treatment of cryoglobulinemia

Answer 30

Plasmapheresis - exchange the good cryoglobulins for the bad
Also treat Hep C
Can also use steroids and cyclophosphamide

Question 31

Henoch Scholein purpura - presentation

Answer 31

Palpable purpura + GI symptoms (pain or bleeding)

Question 32

Diagnosis of HSP

Answer 32

Biopsy

Question 33

Treatment of HSP

Answer 33

Steroids

Question 34

Main difference between treatment of small and medium vs. large vessel?

Answer 34

Addition of cyclophosphamide