Vasculitides

Question 1

Define vasculitis

Answer 1

Vasculitis is the inflammation and necrosis of blood vessels.

Primary vasculitides are classified based on the MAIN VESSEL SIZE affected:
LARGE
Giant cell arteritis
Takayasu’s aortitis

MEDIUM
Polyarteritis nodosa
Kawasaki’s disease

SMALL
Churg-Strauss syndrome
Microscopic polyangiitis
Wegner's granulomatosis
Henoch-Schonlein purpura
Mixed essential cryoglobulinaemia (MEC)
Relapsing polychondritis

Question 2

Explain the aetiology/risk factors of vasculitides

Answer 2

UNKNOWN
Suggested autoimmune origin
Immune complex deposition in the walls of blood vessels leads to inflammation

Risk Factors
Hepatitis B - polyarteritis nodosa
Hepatitis C - mixed essential cryoglobulinaemia
pANCA - microscopic polyangiitis + Churg-Strauss
c-ANCA - Wegner’s granulomatosis

Question 3

Summarise the epidemiology of vasculitides

Answer 3

RARE

Takayasu’s arteritis is most common in Japanese women

Question 4

Recognise the presenting symptoms and signs of vasculitides

Answer 4

Large vessel vasculitides have classic clinical patterns
based on the vessels affected (e.g. GCA and loss of vision/headache)

Medium and small vessel vasculitides are characterised by multiorgan involvement and have
less specific clinical features.

Question 5

Possible Features of ALL Vasculitides

Answer 5

General: fever, malaise, night sweats, weight loss

Skin: rash

Joint: arthralgia, arthritis

GI: abdominal pain, haemorrhage, diarrhoea

Kidneys: glomerulonephritis, renal failure

Lungs: dyspnoea, cough ,chest pain, haemoptysis, haemorrhage

CVS: pericarditis, coronary arteritis, myocarditis

CNS: mononeuritis multiplex, infarctions

Eyes: retinal haemorrhage, cotton wool spot

Question 6

Features Characteristics of Specific Vasculitides

Answer 6

GCA: loss of vision, jaw claudication, headache, scalp tenderness

Polyarteritis Nodosa: microaneurysms, thrombosis, infarctions, hypertension, testicular pain

Henoch-Schonlein Purpura : purpura, arthritis, gut symptoms, glomerulonephritis, IgA deposition

Wegner’s Granulomatosis: granulomatous vasculitis of
upper and lower respiratory tract, nasal discharge, ulceration and deformity, haemoptysis, sinusitis, glomerulonephritis, saddle nose

Question 7

Identify appropriate investigations for

vasculitides

Answer 7

Bloods
FBC - normocytic anaemia, high platelets, high neutrophils
High ESR/CRP

Autoantibodies - e.g. cANCA in Wegner’s

Urine - haematuria, proteinuria, red cell casts (if glomerulonephritis)

CXR - diffuse, nodular or flitting shadows, atelectasis

Biopsy - renal, lung, temporal artery (in GCA)

Angiography - to identify aneurysms (in PAN)