VASCULITIS Flashcards
What is vasculitis?
Vasculitis is a histological term describing inflammation of the vessel wall.
What is large vessel vasculitis?
Vasculitis of the aorta and its major tributaries
What is medium vessel vasculitis?
Vasculitis of the medium and small arteries as well as the arterioles.
What is small vessel vasculitis?
Vasculitis of the small arteries, arterioles, venules and capillaries.
What are the systemic inflammatory vascilitides?
A group of diseases either characterised by widespread vasculitis, or containing vasculitis as a primary component, leading to systemic symptoms. They include: Polymyalgia rheumatica Giant cell arteritis Takayasu's arteritis Polyarteritis nodosa Kawaki's disease Small vessel vasculitis Wegener's granulomatosis Churg-Strauss syndrome Microscopic polyangitis Behcet's disease
What is polymyalgia rheumatica (PMR)?
A syndrome involving sudden onset of severe pain and stiffness of the shoulders and neck, and of the hips and lumbar spine. Symptoms are worse in the morning lasting from 30 minutes to several hours. Clinical history is diagnostic and patients are always over 50 years old. Involves giant cell arteritis is 10-30% of cases.
What is giant cell arteritis (GCA)?
GCA is inflammatory granulomatous arteritis of large cerebral arteries which occurs in association with PMR (polymyalgia rheumatica). The patient may have current PMR, a history of recent PMR, or be on treatment for PMR.
What are the symptoms of giant cell arteritis?
Severe haedaches
Tenderness of the scalp (problems combing hair)
Tenderness of the temple
Claudication (cramping) of the jaw when eating
Tenderness or swelling of one or more temporal or occipital arteries
Painless temporary or permanent loss of vision in one eye
Malaise
Tiredness
Fever
What investigations would you carry out on someone with suspected polymyalgia rheumatica (PMR)? For each investigation state the positive result.
FBC - mild normochromic, normocytic anaemia
LFTs - raised ALP (marker of acute inflammation)
ESR and CRP - raised (hallmark of the condition)
Temporal artery diagnosis - shows giant cell arteritis (GCA)
What investigations would you carry out on someone with suspected giant cell arteritis (GCA)? For each investigation state the positive result.
FBC - normochromic, normocytic anaenia
ESR - raised
CRP - very high
LFTs - raised ALP
Temporal artery biopsy shows histological features of GCA
What are the histological features of giant cell arteritis seen on close inspection of temporal artery biopsy?
Cellular infiltrates of CD4+ T-cells, macrophages and giant cells in vessel wall.
Granulomatous inflammation of the intima and media
Breaking up of internal elastic lamina
Giant cells, lymphocytes and plasma cells in the internal elastic lamina.
Is giant cells arteritis (GCA) more common in men or women?
Women 2:1
What is the treatment of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA)?
PMR: starting dose of 10-15 mg prednisolone OD, which is reduced in weekly steps
GCA: starting dose of 60-100 mg prednisolone, which is reduced in weekly or monthly steps
Calcium, vitamin D and bisphophonates are given to prevent osteoporosis from steroid therapy.
What is Takayasu’s arteritis?
Granulomatous inflammation of the aorta and its major branches. The main signs and complications are reduced blood pressure in one arm compared with the other, aortic insufficiency and renal dysfunction.
