Vasculitis

Question 1

Are there any biomarkers in Takayasu’s?

Answer 1

None except CRP and ESR

Question 2

Role for TNF agents in GCA?

Answer 2

None
IL-6 blocker Tocilizumab in refractory cases
Dont forget to put them on aspirin for CV and cerebrovascular risk

Question 3

Induction for PAN?

Answer 3

cyclo and pred
Then maintain AZA and pred
Also treat the hep B

Question 4

Subglottic stenosis think…

Answer 4

GPA

Question 5

IV vs oral cyclo in Wegner’s?

Answer 5

IV better tolerated, less leukopaenia and lower overall dose, but more relapses but overall no mortality or ESRF effect

Question 6

Organs involved in Churg strauss?

Answer 6

Nerves
Lung
sinus
Kidneys

heart and gut

Remember only 30-40% ANCA positive
eosinophilic- more likely anca neg and more likely heart involvement, less kidney

Question 7

Anti GBM ab is against what?

Answer 7

Type 4 collagen

Question 8

Do you have to be sick pre-GCM?

Answer 8

No,often no prodrome

Question 9

Treat antiGBM ab disease?

Answer 9

PLEX, steroids, cyclo

Question 10

Steroid refractory HSP in adults think?

Answer 10

Solid organ malignancy

Question 11

Natural history of HSP?

Answer 11

90% self limited
pred for abdo pain or arthralgia

if renal involvement 20-40% have long term issues
No benefit steroids in preventing nephritis, altering course nephritis, or preventing relapse
Best NPV for ongoing disease is normal UA 7 days in

Question 12

Type 1 cryo is

Answer 12

Monoclonal Ig

B cell lymphoprolif disorder

Question 13

Type 2 cryo is

Answer 13

Monoclonal IgM  (rarely the others) and polyclonal IgG 
RhF+

Hep C

Question 14

Type 3 cryo is

Answer 14

Polyclonal IgG and IgM

RhF+

Question 15

Treatment for hep C cryo:

Answer 15

Ritux + antivirals better than antivirals alone

Question 16

Treatment for type 1 cryo:

Answer 16

treat haem malig

Question 17

Treatment for non infectious cryo

Answer 17

Ritux + steroids (better than alkylating and steroids)

Question 18

Which vasc has worst mortality?

Answer 18

MPA

Question 19

What do we know about the trials recently and ANCA assoc vasculitis?

Answer 19

In early limited GPA, MTx as good as cyclo but slower onset
Oral is as good as IV cyclo for induction but IV less toxicity and lower overall dose, however higher relapse
Ritux as good as cyclo for induction and maintenance to 18 months
Ritux better in relapsed disease needing reinduction
Renal recovery higher at 1 year with PLEX but no mortality difference
AZA is better than MMF and equivalent to cyclo for maintenance of remission