Vasculitis

Question 1

What is vasculitis?

Answer 1

Inflammation of the blood vessels, with ischaemia, necrosis and organ inflammation

Question 2

What systemic symptoms are associated with vasculitis ?

Answer 2

Fever
malaise
Weight loss
Fatigue

Question 3

What are the two main types of large vessel vasculitis?

Answer 3

Takayasu arthritis (TA)
Giant Cell arthritis (GCA)

Question 4

What age group mainly get TA and GCA?

Answer 4

TA = under 40's
GCA = over 50's

Question 5

Which of either GCA or TA have granulomatous infiltration of the walls of the large vessels ?

Answer 5

Both of them

Question 6

What findings would be present in large vessel vasculitis?

Answer 6

Bruit
Blood pressure difference of extremities
Claudication
Carotodynia or vessel tenderness
Hypertension

Question 7

What disease has a high association with GCA?

Answer 7

Polymyalgia rheumatica

Question 8

What are classic symptoms of Temporal arthritis?

Answer 8

Unilateral temporal headache
scalp tenderness
jaw claudication

Question 9

What causes the possibility of blindness in temporal arthritis?

Answer 9

ischaemia of the optic nerve

Question 10

What investigations are there for temporal arhtritis?

Answer 10

ESR plasma viscosity CRP are all raised
MR angiogram
PET CT scan

Question 11

What is the management for Temporal arthritis?

Answer 11

40-60mg starting dose of prednisolone

Methotrexate or azothiaprine may be used

Question 12

Give 2 examples of medium vessel vasculitis?

Answer 12

kawasaki disease - under 5’s

Polyartheritis, resulting in microaneurysm formation

Question 13

What virus does medium vessel vasculitis have an association with?

Answer 13

Hepatitis B

Question 14

What are some ENT features of vasculitis?

Answer 14

Sinusitis
Nasal crusting
Epistaxis
Mouth ulcers
Sensorineural deafness
Otitis media and deafness
Saddle nose - due to cartilage ischaemia

Question 15

What respiratory problems may accompany vasculitis?

Answer 15

Pulmonary infiltrates
Cough
Hemoptysis
Diffuse alveolar hemorrhage
cavitating nodules on CXR

Question 16

What cutaneous problems may occur in vasculitis?

Answer 16

palpable purpura

Cutaneous ulcers

Question 17

What renal problems may occur in vasculitis?

Answer 17

Necrotising glomerulonephritis

Manifests as blood and protein in urine

Question 18

What nervous system problems may occur in vasculitis?

Answer 18

Mononeuritis multiplex
Sensorimotor polyneuropathy
Cranial nerve palsies

Question 19

What ocular problems may occur in vasculitis?

Answer 19

Conjunctivitis 
Episcleritis
Uveitis
optic nerve vasculitis
retinal artery occlusion
proptosis

Question 20

What occurs in Eosinophilic granulomatosis with Polyangiitis?

Answer 20

late onset asthma and high eosinophil count

Question 21

What is Henoch-Schonlein Purpura? (HSP)

Answer 21

An acute immunoglobulin A (IgA) mediated disorder

Question 22

When do most HSP cases occur?

Answer 22

between the ages of 2-11 years

Question 23

Infection of what organism often accompanies HSP?

Answer 23

Group A Strep (usually occurs up to 3 weeks before HSP)

Question 24

How does HSP present?

Answer 24

Purpuric rash typically over buttocks and lower limbs
Colicky abdo pain
Bloody diarrhoea
joint pain/swelling
Renal involvement (50%)

Question 25

How do you manage HSP?

Answer 25

Tends to resolvewithin 8 weeks
May relapse
Must perfrom urinalysis to screen for renal problems