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Rheumatology > Vasculitis > Flashcards

Vasculitis Flashcards

GCAr Polyarteritis nodosa Microscopic polyangiitis

1
Q

What are the large vessel vasculitides?

A

GCA
Takayasu’s arteritis
Buergers disase

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2
Q

What are the medium vessel vasculitides?

A

Polyarteritis nodosa

Kawasaki disease

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3
Q

What are the small vessel vasculitides

A
  1. ANCA associated:
    - microscopic polyangiitis
    - Wegeners granulamtoiss
    - Churg strauss
  2. Immune complex vasculitis:
    - goodpastures
    - IgA vasculitis (henoch-schonlein)
    - Cryoglobulinaemic vasculitis
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4
Q

How do a lot of vasculitides present?

A

Fatigue + raised ESR/CRP

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5
Q

What is it appropriate to consider if a presentation doesn’t fit into any category?

A

Ca associated

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6
Q

What is the general treatment of large vessel vasculitides?

A

steroids

can add steroid sparing agents

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7
Q

What is the general treatment of medium/small vessel vasculitides?

A

immunosuppression

steroids +/- sparing agent

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8
Q

What is GCA also known as?

A

temporal arteritis

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9
Q

What is GCA commonly associated w?

A

PMR

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10
Q

What age is GCA more common in?

A

> 50

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11
Q

What are the sx of GCA?

A
  1. HEADACHE - new onset usually unilateral in temporal region but can be bilateral and diffuse
  2. TEMPORAL ARTERY - tender, thickened or nodular, may be red w absence or reduced pulse
  3. SCALP TENDERNESS
  4. Tongue/jaw claudicaton
  5. Amaurosis fugax
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12
Q

What is an irreversible complication of GCA?

A

Unilateral blindness (ophthalmic artery)

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13
Q

What are the extra cranial sx of GCA?

A 
malaise
WL
Morning stiffness
SOB
Unequal/weak pulses
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14
Q

How would you make a diagnosis of GCA?

A

≥3 of:

  1. > 50yrs
  2. New headache
  3. Temporal artery tenderness or reduced pulse
  4. ESR >50
  5. Abnormal artery biopsy
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15
Q

What is seen on biopsy in GCA?

A

Necrotising arteries w mononuclear infiltrate or granulomatous inflammation

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16
Q

What blood tests changes would support a diagnosis of GCA?

A

↑platelets
↑CRP
↑ALP
↓Hb

17
Q

What is the management of GCA

A
  1. Prednisolone ASAP 60mg/d PO
    or
  2. IV methylprednisolone if evolving visual loss or Hx of amaurosis fugax

Remember to give:
PPI, bisphosphonates, Ca2+ w cholecalciferol + consider aspirin

18
Q

How long do ppl tend to have GCA before remission?

A

2yrs

19
Q

When should prednisolone dose be reduced in GCA?

A

when sx resolve and ESR ↓

20
Q

what is polyarteritis nodosa (PN)?

A

Necrotising vasculitis causing aneurysms + thrombosis in medium sized arteries, leading to infarction in affected organs w severe systemic sx

21
Q

Which sex is more affected in PN?

A

m>f 2:1

22
Q

What may PN be associated w?

A

Hep B

23
Q

What are the systemic sx of PN?

A

fever
malaise
WL
arthralgia

24
Q

What are the skin features of PN?

A

Rash
‘punched out’ ulcers
nodules
levidoreticularis

25
Q

What are the renal features of PN

A

HTN
RF
Haematuria
proteinuria

26
Q

What are the neurological sx of pN

A

mononeuritis multiplex

sensori-motor polyneuropathy

27
Q

What are the cardiac features of pn

A

angina/MI
HF
Pericarditis

28
Q

What are the GI features of PN

A

pain or perforation

malabsorption

29
Q

What are the GU features of PN

A

orchitis

testicular pain

30
Q

What organs are usually spared in pn

A

lungs

31
Q

What tests would u do in PN?

A
  • FBC: ↓Hb, ↑WCC, mild eosinophilia
  • ↑ESR/CRP
  • ANCA -ve
  • Renal biopsy or angiography
32
Q

What is the rx of polyarteritis nodosa?

A

i. control BP
ii. Steroids - mild cases
iii. Steroid sparing agents if severe

33
Q

What is microscopic polyangiitis (MP)?

A

necrotising vasculitis affecting small and medium vessels

34
Q

What are the sx of MP?

A
  • rapidly progressive GN

- pulmonary haemorrhage

35
Q

How is MP diagnosed?

A

pANCA +ve

36
Q

What is the treatment of MP

A

steroids + e.g. MTX

Maintenance - MTX, ritux, azathioprine

Rheumatology (10 decks)

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