Vasculitis Flashcards
what is vasculitis?
inflammation of the blood vessels
what determines the presentation of vasculitis?
which vessels are affected
what symptoms are common to all types of vasculitis?
systemic symptoms - fever, weight loss, fatigue
what is primary vasculitis?
due to an inflammatory response that targets the vessel walls with no known cause
what is secondary vasculitis?
triggered by something specific e.g. infection, drugs, toxins, other inflammatory disorder, cancer
what are the two main forms of large vessel vasculitis?
takayasu’s arteritis (TA)
giant cell arteritis (GCA)
what causes large vessel vasculitis?
granulomatous infiltration of the walls of the large vessels
what investigations should be done for suspected large vessel vasculitis?
inflammatory markers
temporal artery biopsy
USS
PET CT/CT angiogram
what is the management for large vessel vasculitis?
start 40-60mg prednisolone
consider steroid sparing agents
name two steroid sparing agents
leflunomide
methotrexate
what drug can be given to patients with relapsing or resistant GCA?
tocilizumab
who is most commonly affected by takayasu’s arteritis?
females <40
asian populations
what can be heard on auscultation in takayasu’s arteritis?
bruits
most commonly in the carotid artery
what blood pressure finding is seen in takayasu’s arteritis?
blood pressure differences at the extremities
what investigation should be done if takayasu’s arteritis is suspected?
angiogram
what age group is GCA common in?
over 50’s
what is another name for GCA?
temporal arteritis
how does GCA present?
unilateral acute temporal headache
scalp tenderness
temporary visual disturbances
jaw claudication
what condition is GCA strongly associated with?
polymyalgia rheumatica
what are the two categories of small vessel vasculitis?
ANCA associated
non ANCA associated
name the three types of ANCA vasculitis
granulomatosis with polyangiitis (GPA)
eosinophilic granulomatosis with polyangiitis (EGPA)
microscopic polyangiitis (MPA)
what did GPA used to be called?
wegener’s granulomatosis
describe a classical GPA patient
northern european
male
35-55
what are the main differences between GPA and EGPA?
late onset asthma
high eosinophil count
what is a common complication of MPA?
renal impairment
name a non-ANCA vasculitis
henoch-schoenlein purpura (HSP)
what ANCA is seen in GPA?
cANCA
what ANCA is seen in EGPA?
pANCA
what ANCA is seen in MPA?
pANCA
what does ANCA stand for?
anti neutrophil cytoplasmic antibodies
what is HSP?
an acute IgA mediated disorder causing a generalised vasculitis
who is most commonly affected by HSP?
children 2-11
what are most cases of HSP preceded by?
URTI/pharyngeal infection/GI infection
usually 1-3 weeks prior
how does HSP present?
purpuric rash over buttocks/lower limbs
colic
bloody diarrhoea
joint pain + swelling
what is a possible complication that occurs in 50% of HSP cases?
renal involvement
what is a possible complication that occurs in 50% of HSP cases?
renal involvement
