Vasculitis Flashcards
What are the systemic manifestations of vasculitis?
fever, malaise, fatigue, weakness, anorexia, weight loss
What are the skin manifestations of vasculitis?
purpura, ulcers, nodules, necrosis
What are pulmonary manifestations of vasculitis?
infiltrates, nodules, hemoptysis
What are oropharyngeal manifestations of vasculitis?
sinusitis
What are CV manifestations of vasculitis?
MI, CHF, HTN, claudication
What are MSK manifestations of vasculitis?
arthralgia, arthritis, myalgia
What are renal manifestations of vasculitis?
hematuria, proteinuria, casts, HTN, acute renal failure
In general, _____ is critical to diagnosing vasculitis
biopsy
What other tests might be helpful in diagnosing vasculitis?
chest X ray liver tests- elevated creatinine- elevated UA- proteinura, hematuria ANCA HBV/ HCV ANA RH
What treatment is used for vasculitis?
corticosteroids +/- azothioprine, methotrexate, mycophenolate mofetil
Diagnose:
New headache, jaw claudication, blindness, polymyagia rheumatica Temporal artery tenderness, loss of pulse
ESR> 50 mm
Temporal artery biopsy shows a granulomatous or mononuclear infiltrate in the artery, fragmentation of the internal elastic lamina
giant cell arteritis
- age generally >50
usually monophasic
start steroids immediately
Diagnose:
young female
claudication of extremities, pulseless on exam
bruit over subclavian artery/ abdominal aorta
abnormal arteriogram
Takayasu’s arteritis
Diagnose: HBV+ weight loss vascular purpura, livedo reticularis myalgia, arhtralgia one or more mononeuropathies HTN focal segmetnal vasculitis on arteriogram biopsy shows necrotizing vasculitis
Polyarteritis nodosa
Diagnose:
HCV+
palpable purpura, myalgia, arthralgia
serum cryoglbulins, RH, hypocomplementemia
cryoglobulinemic vasculitis
Diagnose:
Sinusitis, epistaxis, otitis media
Chest x-ray w/ nodules, infiltrates, cavities
Proteinuria, hematuria, RBC casts
c-ANCA+
Pauci-immune glomerulonephritis
Granulomatous inflammation within or adjacent to an artery wall
Granulomatosis with polyangiitis
How is granulomatosis with polyangiitis treated?
Rituximab
Diagnose: pulmonary infiltrates on chest X ray proteinuria, hematuria, RBC casts p-ANCA and MPO+ pauci-immune glomerulonephritis necrotizing vasculitis on biopsy
microscopic polyangiitis
Diagnose: hx of asthma, allergic rhinitis eosinophilia non-fixed pulmonary infiltrates cardiomyopathy, MI p-ANCA+ extravascular eosinophils on biopsy
eosinophilic granulomatosis with polyangiitis
Diagnose: painful recurrent oral and genital ulcers uveitis, retinal vasculitis erythema nodosum, severe acne DVTs aseptic meningitis
Bechet’s disease
Describe the epidemiology of Bechet’s disease
More common in Mediterranean heritage, more severe in men
onset in 2nd or 3rd decade of life
What aspects of Bechet’s disease increase mortality?
bleeding pulmonary artery and gastrointestinal aneurysms, CNS involvement
How is Bechet’s disease treated?
Local corticosteroids for ulcers
azothioprine for eye involvement
Diagnose:
stiffness and soreness in the shoulders and hips, worse in the morning
polymyalgia rheumatica
Describe the epidemiology of polymyalgia rheumatica
more common in N Europeans, onset 50-80 years
associated with giant cell arteritis
