Vasculitis

Question 1

Large vessel vasculitis

Answer 1

Polymyalgia Rheumatica
Takayasu’s Arteritis
Temporal Arteritis

Question 2

Medium vessel vasculitis

Answer 2

Buerger’s Disease
Polyarteritis Nodosa
Kawasaki Disease
Cutaneous Vasculitis

Question 3

Small vessel vasculitis

Answer 3

Behcet’s
Eosinophilic granulomatosis with Polyangitis
Henoch-Schonlein Purpura
Microscopic Polyangitis

Question 4

Polymyalgia Rheumatica

Answer 4

LVV
Pain and stiffness in neck/shoulders/upper arms and hips.
Epid: Patients >50, Females twice as likely, Caucasians/Scandinavians
Aet: Cause unknown
HLA-DR4 associated
HPC: Sudden/gradual onset pain in neck, shoulders and hips WORSE IN MORNING/EVENING // Limitation of activity // Fatigue, weakness, low-grade fever // limitation in shoulder motion/swelling joints
Ix: Elevated ESR and CRP
Mx: 10-20mg oral prednisolone –> improve in 3 days
Exercise to rebuild muscle strength
15% also have Temporal Arteritis

Question 5

Takayasu’s Arteritis

Answer 5

LVV
Granulomatous vasculitis of the aorta and its major branches. Inflammation –> stenosis, thrombosis and aneurysms.
Associated fibrosis of the intima of the vessels. More common in aorta but can also affect pulmonary arteries.
Females 8-9 times more affected. Young/middle aged Asian women.

HPC: Systematic symptoms: Fever, malaise, night sweats, arthralgia.
Upper limb claudication –> subclavian artery involvement
Hypertension –> renal artery stenosis
Neurological manifestations –> carotid artery involvement

Question 6

Temporal Arteritis

Answer 6

LVV aka Giant Cell Arteritis
Inflammatory disease involving the large and small vessels of the head, particularly branches of Ext. Carotid.
Generally effects the vasa vasorum which supply larger arteries –> inflammation leads to granulomatous infiltrates in these vessels that can cause occlusion and ischemia.
Epid: Patients >55 (v. rare in younger). Females twice as likely.
Involvement of opthalmic artery (branch of ICA) is medical emergency.
HPC: Headache, scalp tenderness, jaw claudication. May have fever. Blurred vision, double vision or acute visual loss may indicate opthalmic involvement.
O/E: Prominent temporal arteries w/o pulsation. Temporal tenderness. Fundoscopy may show ischaemia.
Ix: Elevated ESR and CRP, maybe abnormal LFTs
TEMPORAL ARTERY BIOPSY - Gold standard
Mx: High dose IV corticosteroids.
Oral steroids given and tapered over 9-12months.
50% also have Polymyalgia Rheumatica

Question 7

Buerger’s Disease

Answer 7

MVV

Question 8

Polyarteritis Nodosa

Answer 8

MVV

Question 9

Kawasaki Disease

Answer 9

MVV

HepB associated

Question 10

Cutaneous Vasculitis

Answer 10

MVV

Question 11

Young/middle aged Asian female
Upper limb claudication
Hypertension
Headache

Answer 11

Takayasu’s Arteritis
Upper limb claudication –> subclavian artery involvement
Hypertension –> renal artery stenosis
Neurological manifestations –> carotid artery involvement

Question 12

50+ Female pt

Headache, scalp tenderness, jaw claudication. May have fever. Blurred vision, double vision or acute visual loss

Answer 12

Temporal Arteritis (aka Giant Cell Arteritis)