Vasculitis Flashcards
What is vasculitis?
Inflammation of blood vessels
Clinical features arise from damage to blood vessel walls
What can cause vasculitis?
Idiopathic Infection Inflammatory disease Drug induced Neoplastic
What are symptoms of vasculitis?
Fever Malaise Weight loss Arthraligia Hameopytsis Epistaxis GI bleeding Haematuria Visual changes
What investigations are done for suspected vasculitis?
Urine dip
Bloods
- FBC
- U+Es
- CRP
- LFTs
- Coag
- ANA
- ANCA
- Anti-GBM
CXR
How is vascilitis classified?
Small vessel
Medium vessel
Large vessel
What are small vessel vasculitides?
Henoch-schonlein purpura Collagen vascular disease Microscopic polyangitis Wegener's Churg-strauss
What are medium vessel vasculitides?
Polyarteritis nodosa
Kawaski disease
What are large vessel vasculitides?
Takayasu arteritis
Giant cell arteritis
What is Henoch-schonlein purpura?
IgA vasculitis
How does Henoch-schonlein purpura present?
Purpura ( purple marks that don’t disappear when pressed) over legs and buttocks
What are collagen vascular disease?
RA
Sjogren’s syndrome
SLE
What is microscopic polyangitis?
ANCA associated vasculitis
What is Wegener’s?
Granulomatosis with polyangitis
What are the symptoms of Wegener’s?
ELK classification
ENT
- sinusitis
Lungs
- dyspnoea
- haemopytisis
- wheeze
Kidneys
- haematuria
- proteinuria
What proteins are associated with Wegeners?
PR3
C-ANCA
How do you induce remission in Wegener’s?
Cyclophoshamide OR rituximab
+
Prednisolone
How do you maintain remission in Wegener’s?
Azathioprine/methotrexate
What is Churg-Strauss?
Eosinophilic granulomatosis with polyangitis
What are the 6 criteria of Churg-Strauss?
Asthma Eosinophilia Paranasal sinusitis Pulmonary infiltrates Histological confirmation Mononeuritis/polyneuropathy
How many of the Churg-Strauss criteria do you need to make a diagnosis?
4
What proteins are associated with Churg-Strauss?
MPO
P-ANCA
How do you induce remission in Churg-Strauss?
Cyclophosamide OR rituximab
+
prednisolone
How do you maintain remission in Churg-Strauss?
Azathioprine/methotrexate
What is polyarteritis nodosa?
Necrotising vasculitis that causes aneurysms and thrombosis
What are the symptoms of polyarteritis nodosa?
Weight loss Livedo reticularis Testicular pain/tenderness Myalgias Mononeuropathy Polyneuropathy Hypotension <90
What are the diagnostic criteria for polyarteritis nodosa?
Weight loss >4kg Livedo reticularis Testicular pain/tenderness Myalgias Mononeuropathy or polyneuropathy Hypotension <90 Elevated kidney blood tests (urea >14.3) Evidence of hep B Presence of granulocyte or mixed leukocyte infiltrate in arterial wall biopsy
How many diagnostic criteria do you need for polyarteritis nodosa?
3
What infection is associated with polyarteritis nodosa?
Hepatitis B
How do you investigate suspected polyarteritis nodosa?
Hep B antigen
ESR
FBC - neutrophilia
Biopsy arteries
How is polyarteritis managed?
Steroid + cyclophoshamide to induce remission
Azathioprine for maintenance
What is Kawasaki disease?
Autoimmune vasculitis affecting children
What are the symptoms of Kawasaki disease?
Fever
Swollen neck glands
Chest rash
Red peeling skin on palms and soles
How is Kawasaki disease managed?
Gamma globulin
Aspirin
What is Takayasu arteritis?
Systemic vasculitis affecting aorta and its branches
What are the symptoms of Takayasu arteritis?
Depend on arteries involved
Aortic arch
- dizziness
- visual changes
- weak arm pulses
Raised BP
Fever
Malaise
What are complications of Takayasu arteritis?
Aortic regurg
Aortic aneurysm
Aortic dissection
Ischaemic stroke
How is Takayasu arteritis managed?
Prednisolone
