Vasculitis

Question 1

What is vasculitis

Answer 1

Inflammation of blood vessels, often with ischemia, necrosis and organ inflammation

Question 2

What blood vessels can be affected by vasculitis

Answer 2

Any - arteries, veins, capillaries, aterioles, venules

Question 3

What does primary vasculitis result from

Answer 3

An inflammatory response that targets the vessel walls and has no known cause (sometimes autoimmune and identified by auto-antibodies)

Question 4

How can secondary vasculitis be triggered

Answer 4

Infection, a drug or toxin, as part of another inflammatory disorder or cancer

Question 5

What histologically happens in the vessel

Answer 5

There are lots of white cells - indicative of inflammation and this has been triggered by an inflammatory reaction (autoimmune or infection)
The white cells release cytokines and they help the inflammatory process and damage tissues
Over time this causes thickening of the vessel wall and causes the lumen to narrow and restrict the amount of blood to the organ that that vessel is supplying.
The lining of that vessel loses its smoothness and becomes irregular and can cause clots to form

Question 6

The presentation of vasculitis depends on what

Answer 6

The vessel it affects

Question 7

What are some of the common systemic symptoms for vasculitis

Answer 7

Fever
Malaise
Weight loss
Fatigue

Question 8

What are the two main causes of large vessel vasculitis

Answer 8

Takayasu arteritis (TA) and 
Giant cell arteritis (GCA)

Question 9

Who does TA affect

Answer 9

Those under 40 and commoner in females. Often Asian population

Question 10

Who does GCA affect

Answer 10

Those over 40 - typically causes temporal arteritis but the aorta and other large vessels may be affected

Question 11

What are both TA and GCA characterised by

Answer 11

Granulomatous infiltration of the walls of the large vessels

Question 12

What is a granuloma

Answer 12

An area formed by the body to wall off something that the body sees as a threat and it can’t be expelled

Question 13

What are some of the clinical findings in a patients with large vessel vasculitis

Answer 13

Bruit (carotid artery especially)
BP differences of extremities (1 arm could be different to the opposite)
Claudication
Carotodynia or vessel tenderness
Hypertension

Question 14

What are the classic symptoms of Temporal arteritis

Answer 14

Unilateral temporal headache
scalp tenderness
jaw claudication

Question 15

Why is there a risk of blindness in temporal arteritis

Answer 15

It could lead to Ischaemia of the optic nerve

Question 16

What investigations should be done for large vessel Vasculitis

Answer 16

ESR, Plasma viscosity and CRP are raised
Temporal biopsy might be helpful
Imaging - MR or PET CT may show vessel wall thickening

Question 17

How can we manage a patient with large vessel vasculitis

Answer 17

Steroids with a starting does of 40-60

Steroid sparing agents such as methotrexate or azathioprine may be considered

Question 18

What type of medium vessel vasculitis is seen in children

Answer 18

Kawasaki disease

Under 5 years old

Question 19

What vessels in Kawasaki disease are the most important vessels to intervene with

Answer 19

Coronary arteries

Question 20

What is the name of the medium vessel vasculitis that presents in adults

Answer 20

Polyarteritis nodosa

Question 21

How is polyarteritis nodosa characterised

Answer 21

BY necrotising inflammatory lesions that affect arteries at vessel bifurcations resulting in micraneuryms formation and aneyrsysms

Question 22

What does medium vessel vasculitis often affect

Answer 22

SkinGut and kidneys

Question 23

What is medium vessel vasculitis associate

Answer 23

Hepatitis B