Vasculitis Flashcards
Systemic Sx
Fever
Malaise
Weight loss
Arthralgia / myalgia
Skin Sx
Purpura
Ulcers
Lived reticularis - pink / blue mottling
Nail bed infarct
Eye Sx
Scleritis
Episcleritis
Visual loss
ENT Sx
Epistaxis Sinusiitis Nasal crusting Stridor Deaf
Cardiac Sx
Angina
MI
HF
Pericarditis
Resp Sx
Haemoptysis
Dyspnoea
Pulmonary haemorrhage
Fibrosis
GI Sx
Pain
Perforation
Malabsorption
Renal Sx
Hypertension Haematuria Proteinuria Renal casts Failure GN ANCA +ve
Neuro Sx
Stroke Seizure Chorea Psychosis Confusion Impaired cognition Altered mood CN palsy
GUI Sx
Orchitis
Small vessel vasculitis
HSP - see paeds
Granulomatis polyangiitis / macroscopic
Microscopic polyangitiis
Eosinophilic (Churg Strauss)
Medium vessel vasculitis
Polyarteritis nodosa
Kawasaki - see pads
Large vessel
GCA - see ophthalmology
Takayasu - see cardio
Variable vessel
Bechet’s
How does granulomatous vessel present and what Ab
C-ANCA +Ve with Ab against proteinase 3 Necrotising granulomatous URTI - epistaxis / sinusitis / deaf / pharyngitis = common Nasal deformity common Very rare without nasal Sx LRTI - cough / SOB / haemoptysis GN common - Focal necrotising with crescents Other features - Scleritis - Pericarditis - Fever - Weight loss - Rash Higher risk of AKI if colonised with staph
How does microscopic present
pANCA +Ve with Ab against myeloperoxidase Necrotising vasculitis No granulomas Similar presentation Lung + kidney GN = more common Pulmonary haemorrhage
How does eosinophilic present
Necrotising granulomatous
Resp tract
Asthma + eosinophilia
ANCA +ve if GN present
Investigation vasculitis
FBC, U+E, LFT ESR / CRP ANCA Urine microscopy Renal biopsy Angiography may be needed
What is common presentation
Fatigue with raised ESR. /CRP
How do you treat
Steroids + steroid sparing if large / flare
Immunosuppression for other - cyclophosphamide / methotrexate
Biologics - ritixumab
Plasma exchange if renal failure / anti-GBM
HSP and Kawasaki is different
How does polyarteritis present
Aneurysms Thrombosis Fever / malaise / arthralgia Weight loss Lived reticularis rash Testicular pain Haematuria / renal failure
Who is it common in
Hep B
Middle aged men
How do you Dx
Renal biopsy
Bloods
Increased WCC / ESR / CRP
Anaemia
ANCA -ve
