What are the large vessel vasculitides?
GCA
Takayasu’s arteritis
Buergers disase
What are the medium vessel vasculitides?
Polyarteritis nodosa
Kawasaki disease
What are the small vessel vasculitides
- ANCA associated:
- microscopic polyangiitis
- Wegeners granulamtoiss
- Churg strauss - Immune complex vasculitis:
- goodpastures
- IgA vasculitis (henoch-schonlein)
- Cryoglobulinaemic vasculitis
How do a lot of vasculitides present?
Fatigue + raised ESR/CRP
What is it appropriate to consider if a presentation doesn’t fit into any category?
Ca associated
What is the general treatment of large vessel vasculitides?
steroids
can add steroid sparing agents
What is the general treatment of medium/small vessel vasculitides?
immunosuppression
steroids +/- sparing agent
What is GCA also known as?
temporal arteritis
What is GCA commonly associated w?
PMR
What age is GCA more common in?
> 50
What are the sx of GCA?
- HEADACHE - new onset usually unilateral in temporal region but can be bilateral and diffuse
- TEMPORAL ARTERY - tender, thickened or nodular, may be red w absence or reduced pulse
- SCALP TENDERNESS
- Tongue/jaw claudicaton
- Amaurosis fugax
What is an irreversible complication of GCA?
Unilateral blindness (ophthalmic artery)
What are the extra cranial sx of GCA?
malaise WL Morning stiffness SOB Unequal/weak pulses
How would you make a diagnosis of GCA?
≥3 of:
- > 50yrs
- New headache
- Temporal artery tenderness or reduced pulse
- ESR >50
- Abnormal artery biopsy
What is seen on biopsy in GCA?
Necrotising arteries w mononuclear infiltrate or granulomatous inflammation
What blood tests changes would support a diagnosis of GCA?
↑platelets
↑CRP
↑ALP
↓Hb
What is the management of GCA
- Prednisolone ASAP 60mg/d PO
or - IV methylprednisolone if evolving visual loss or Hx of amaurosis fugax
Remember to give:
PPI, bisphosphonates, Ca2+ w cholecalciferol + consider aspirin
How long do ppl tend to have GCA before remission?
2yrs
When should prednisolone dose be reduced in GCA?
when sx resolve and ESR ↓
what is polyarteritis nodosa (PN)?
Necrotising vasculitis causing aneurysms + thrombosis in medium sized arteries, leading to infarction in affected organs w severe systemic sx
Which sex is more affected in PN?
m>f 2:1
What may PN be associated w?
Hep B
What are the systemic sx of PN?
fever
malaise
WL
arthralgia
What are the skin features of PN?
Rash
‘punched out’ ulcers
nodules
levidoreticularis
