Systemic Vasculitis

Question 1

What is vasculitis? [1]

Answer 1

a group of conditions characterised by inflammation of the blood vessel walls that compromise the vessel integrity

Question 2

What are the common causes of secondary vasculitis? [4]

Answer 2

1. Infection → Hep B/C, meningococcal septicaemia, streptococcus
2. Underlying disease → cancer, Rheumatoid/SLE/IBD
3. Cold injury
4. Drugs → antithyroid drugs (carbimazole, Antibiotics (sulphonamides/penicillin)

Question 3

What are the main presenting features of primary vasculitis? [6]

Answer 3

1. fever,
2. night sweats,
3. malaise,
4. weight loss → “algia” (myalgia, arthralgia)

Question 4

What are the specific major complications caused by the following types of vasculitis:

1. Large vessel? [2]
2. Medium vessel? [2]
3. Small vessel? [1]

Answer 4

1. Large vessel → end organ ischaemia or infarction
2. Medium → localised ischaemia or infarction
3. Small → organ specific inflammation

Question 5

Name 2 types of large vasculitis (state which one is common and which one is rare) [2]

Answer 5

1. Giant cell arteritis (common)
2. Takayasu (rare)

Question 6

What age group is giant cell arthritis common in? [1]

Answer 6

the elderly

Question 7

What is the common artery affected in giant cell arteritis? [1]

Answer 7

Temporal artery

Question 8

What are the clinical features of large vessel vasculitis? [4]

Answer 8

1. fatigue,
2. headache,
3. jaw claudication,
4. scalp tenderness

Question 9

What investigations should you carry out on a patient with suspected giant cell arteritis? [2]

Answer 9

1. ESR (↑↑)
2. Temporal artery biopsy

Question 10

Name a severe complication of temporal arteritis [1]

Answer 10

Sudden irreversible visual loss

Question 11

What are the 2 medium vasculitis? [2]

Answer 11

1. Polyarteritis Nodosa
2. Kawasaki disease

Question 12

Any organ can be affected in polyarteritis nodosum, but which organ is particularly susceptible and what are the complications as a result of this organ getting affected? [4]

Answer 12

1. Kidneys
2. complications:
   
   • renal artery stenosis,
   • renal aneurysms,
   • hypertension

Question 13

What is the triad of symptoms in Henoch-Schönlein purpura (HSP)? [3]

Answer 13

1. palpable purpura
2. arthritis/arthralgia
3. abdo pain

Question 14

ANCA:

1. What does ANCA stand for? [1]
2. What are the 2 types of ANCA and which type of vasculitis is indicated for each one? [2]

Answer 14

1. Anti-neutrophil cytoplasmic antibody
2. cANCA
   
   • granulomatous polyangiitis (Wegener’s)
3. pANCA:
   
   • microscopic polyangiitis (MPA) → also MPO +ve