Vasculitis Flashcards
What situations should make you consider a systemic vasculitis?
- Palpable purpura (raised purple lesion in lower extremities. No need to biopsy!
- Glomerulonephritis (usually small vessel)
- Disease of the old in the young (stroke, MI)
- Multisystem disease occurring simultaneously
- Wasting diseases or fever w/o known origin
- Mononeuritis multiplex (infarction of peripheral nerves)
What should you do if you suspect a vasculitits?
Find other organ manifestations (urinalysis, CXR, LFTs, EMG, etc)
Order ANCAs
What are the different types of ANCAs and what do they detect?
cANCA: reacts with serine proteinase 3 (PR3)
pANCA: reacts with myeloperoxidase (MPO)
Which ANCAs would be positive in Wegener’s?
cANCA/PR3
Which ANCAs would be positive in microscopic polyangiitis?
pANCA/MPO
What is the gold standard in diagnosing vasculitides?
BIOPSY. Also need to know organ involvement in order to start trying to characterize the type of vasculitis
What is the difference between primary, secondary, and pseudovasculitis?
Primary: No known antigen
Secondary: known antigen
Pseudo: Vessel occlusion NOT due to vessel wall destruction
You see a skin rash, bloody diarrhea, GN, and arthralgias. You see IgA in the vessels. What vasculitis is this?
Henoch-Schoenlein purpura
What is another name for Henoch-Shoenlein Purpura?
Hypersensitivity vasculitis–>because similar findings in drug rxns
What are some skin clues that you’re looking at a vasculitis?
- purpura
- stellate ulcers
- nodules
- Ischemic digits
- reticulated purpura
What are the large vessel vasculitides?
Giant cell
Takyasu
What are the medium vasculitidies?
Kawasaki
Polyarteritis nodosa
What are the small vessel vasculitides?
Wegener’s
Churg-Strauss
Microscopic polyangiitis
Henoch-Schoenlen Purpura
A patient coming from from traveling abroad to southeast asia has gut experiences HTN, ulcers, and anorexia. He also develops a coronary aneurysm. What vasculitis is this?
Polyarteritis nodosa. Assoc’d with gut ischemia and renal artery involvement–>HTN
Mononeuritis
What other disease MUST you keep in mind when diagnosing polyarteritis nodosa?
nearly UNIVERSALLY secondary to Hep B. Check liver function tests, AST and ALT
What are causes of secondary vasculitis?
hepatitis Herpes SLE Drugs Malignancy cardiac myxoma cryoglobulins
A 35 yo man has eye inflammation, sinusitis, lung lesions, hemoproteinuria, and digital gangrene. What vasculitis is this?
Wegener’s granulomatosis or (Granulomatosis with polyangiitis, GPA)
What is the classic traid of wegener’s (GPA)?
- Vasculitis
- Granuloma in respiratory tract
- Pacui-immune glomerulonephritis
What are features of the ANCA positive vasculitides?
They are fairly common diseases and all have a pulmonary (nodules)-renal (GN) syndrome
What are the features of giant cell arteritis?
Age>50
New onset headache
amaurosis fugax
Takayasus aortitis
Prevalent in asian women INFLAMMATION of AORTA -Fever, malaise, weight loss -HTN, claudication -Visual changes -Dizziness/imbalance
What is the disease process in GCA/TA?
Mononuclear infiltrate destroys the elastic lamina of arteries
How do you diagnose a vasculitis?
BIOPSY. If unavailable, consider an angiography
65 yo woman with painful necrotic skin lesions on thighs and calves. Weight loss.
More likely to be a vasculopathy: NON-inflammatory vessel obstruction like cholesterol emboli or DIC.
