Rheumatology

Question 1

Ongoing management of ANCA+ Vasculitis

Answer 1

Goals:

• Monitor disease activity & maintain remission
• Prevent complications

Confirm dx

• ANCA, tissue biopsies

Monitor disease activity & treating exacerbation

• Ix - 3 monthly
  
  • History & exam - respiratory symptoms, neuropathy, rash
    
    • Best as ANCA is controversial, ESR/CRP are non-specific
  • MPA/GPA: ANCA titre, ESR, CRP, EUCs, UA
  • EGPA: above + Eosinophils
  • Organ-specific: e.g. CT chest, PFT, TTE
  • Tissue biopsy
• Mx
  
  • Induction: steroids (1mg/kg) + rituximab or cyclophosphamide
  • Maintenance: rituximab, AZA, MTX, MMF

Monitor for complications (cardiovascular, ImmSx, steroids)

• Ix: 3 monthly FBC (cyclophosphamide, MTX), LFTs, lipids, HBA1C, DEXA (steroids), VitD/Ca/PTH (steroids). Ig levels.
• Mx:
  
  • CV risk factor Mx
  • Vaccination
  • Infection Prophylaxis (e.g. Bactrim)
  • Malignancy screening
  • Fertility (cyclophosphamide)