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MSK SOH > Vasculitis > Flashcards

Vasculitis Flashcards

1
Q

Definition

A

Inflammation of blood vessels

Different sizes of blood vessels can be affected

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2
Q

Pathogenesis

A

WBC or immune complexes are present in the vessel wall

This damages the structure of the vessel wall leading to narrowing which ultimately causes ischaemia and claudication

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3
Q

2 types of large vessel vasculitis

A 
Giant cell arteritis (GCA) 
Takayasu arteritis (TA)
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4
Q

GCA - definition

A

Granulomatous vasculitis affecting large arteries. It primarily affects the branches of the external carotid artery

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5
Q

GCA - epidemiology

A

Over 50

More common in women

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6
Q

GCA - clinical features

A

Headaches affecting the temples
Scalp tenderness
Jaw claudication
Sudden changes in vision (blindness)

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7
Q

GCA - examination

A

bruit (due to turbulent blood flow)

Loss of pulse at temporal artery

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8
Q

GCA - investigations

A

Inflammatory markers - raised

Temporal artery biopsy

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9
Q

GCA - management

A

High dose steroids (40-60mg prednisolone)

If patient is suffering from loss in vision then use higher dose of steroid

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10
Q

TA - definition

A

Vasculitis affecting the large arteries - mainly the aorta and pulmonary artery

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11
Q

TA - epidemiology

A

Under 40

Commonly affects females

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12
Q

TA - clinical features

A

Initially non-specific: malaise, fatigue, weight loss, lightheaded, SOB, chest pain
Arm/leg pain when moving

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13
Q

TA - investigations

A

Inflammatory markers - raised

PET CT scanning

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14
Q

TA - management

A

High dose steroids (40-60mg prednisolone)

Immunosuppression

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15
Q

2 main types of ANCA +ve small vessel vasculitis

A

Granulomatosis with polyangiitis (GPA) - aka Wegners

Eosinophilic granulomatosis with polyangiitis (EGPA) - aka churg strauss

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16
Q

GPA - definition

A

Systemic small vessel vasculitis which involves the respiratory tract along with other organs
+ve ANCA

17
Q

GPA - epidemiology

A

Commonly affects males

Age: 35-55

18
Q

GPA - clinical features

A

ENT involvement
- hearing loss, nose bleeds, sinusitis, mouth ulcers, defects of cartilage in nose (saddle shaped nose)
Resp involvement
- cough, haemoptysis, round cavitiating granuloma
Skin involvement
- purpuric rash, on lower legs, palpable
Kidney involvement

19
Q

GPA - investigations

A 
ANCA testing 
cANCA - specific for GPA 
anti-PR3 - varies with disease activity 
Complement levels - decreased 
Do renal biopsy to check for renal involvement
20
Q

GPA - management

A

Localised: methotrexate/azathioprine + steroids
Generalised: IV cyclophosphamide + IV steroids

21
Q

EGPA - definition

A

Systemic small vessel vasculitis which involves the respiratory tract and other organs. Eosinophils are found in high levels
ANCA +ve

22
Q

EGPA - epidemiology

A

Middle aged

23
Q

EGPA - clinical features

A

LESS ENT INVOLVEMENT THAN GPA
late onset asthma
rhinitis

24
Q

EGPA - investigations

A

Increased eosinophil count
Biopsy - proof of vasculitis with extravascular eosinophils
ANCA testing
pANCA
anti-MPO - varies with disease activity
Complement levels - decreased
Do renal biopsy to check for renal involvement

25
Q

EGPA - management

A

IV cyclophosphamide + IV steroids

26
Q

Non ANCA associated small vessel vasculitis (1)

A

Henoch- Schonlein Purpura (HSP)

27
Q

HSP - definition

A

Acute IgA mediated disorder characterised by a generalised vasculitis associated with other body systems

28
Q

HSP - epidemiology

A

Commonly affects children

29
Q

HSP - clinical features

A

Hx of URTI provokes disease
Purpuric rash over buttocks and lower limbs
Joint pain
Vomiting, diarrhoea, abdo pain

30
Q

HSP - causative organism

A

Usually group A strep

31
Q

HSP - investigations

A

Urinalysis (check for renal involvement)

32
Q

HSP - management

A

Self limiting

MSK SOH (24 decks)

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