Vasculitis

Question 1

What is vasculitis?

Answer 1

An inflammatory blood vessel disorder

Question 2

What are the small vessel vasculitis + their associated autoantibodies?

Answer 2

• microscopic polyangiitis - p-ANCA
• granulomatosis with polyangiitis - c-ANCA
• **eosinophilic granulomatosis with polyangiitis - p-ANCA + raised eosinophils
• IgA vasculitis

Question 3

What are the medium vessel vasculitis?

Answer 3

Polyarthritis nodosum
Kawasaki disease

Question 4

What are the large vessel vasculitis?

Answer 4

Giant cell arteritis
Takayasu’s arteritis

Question 5

What type of vessel does IgA vasculitis affect?
What are the key features?

Answer 5

Small vessel
Purpura
IgA nephritis

Question 6

What type of vessel does microscopic polyangiitis affect?
What are the key features?

Answer 6

Small blood vessels
Glomerulonephritis
Diffuse alveolar haemorrhages

Question 7

What type of vessel does granulomatosis with polyangiitis affect?
What are the key features?

Answer 7

Small blood vessels
Nasal + respiratory symptoms
Glomerulonephritis

Question 8

What type of vessel does eosinophilic granulomatosis with polyangiitis affect?
What are the key features?

Answer 8

Small blood vessels
Late-onset asthma
Sinusitis + rhinitis

Question 9

What type of vessel does polyarthritis nodosa affect?
What are the key features?

Answer 9

• Medium sized blood vessels
• Renal impairment
• Hypertension
• Cardiovascular events
• Tender skin nodules

Question 10

What type of vessel does Kawasaki disease affect?
What are the key features?

Answer 10

• Medium sized blood vessels
• widespread rash
• high fever for >5/7
• bilateral conjunctivitis
• strawberry tonge
• coronary artery aneurysms

Question 11

What type of vessel does giant cell arteritis affect?
What are the key features?

Answer 11

Large blood vessles
Unilateral headache
Scalp tenderness
Visual disturbance

Question 12

What type of vessel does Takayasu arteritis affect?
What are the key features?

Answer 12

Large blood vessels
Aortic arch affected
‘Pulseless’ disease

Question 13

Investigations of vasculitis

Answer 13

• raised inflammatory markers *e.g. CRP+ESR
• ANCA (anti-neutrophil cytoplasmic antibodies)
• urine dipstick for renal involvement

Question 14

Management of vasculitis

Answer 14

• rule out infection
• stop offending drugs in secondary casues
• 1st line: corticosteroids
• 2nd line: biological agents or immunomodulatory drugs e.g. cyclophosphamide, rituximab, methotrexate

Question 15

How do clinical features arise in vasculitis?

Answer 15

Due to damage of blood vessel walls with subsequent thrombosis, ischameia, bleeding and/or aneurysm formation