vasculitis Flashcards
what is vasculitis?
An inflammatory blood vessel disorder
Clinical features result from the damage of blood vessel walls with subsequent thrombosis, ischemia, bleeding, and/or aneurysm formation.
Vasculitis is a large, heterogeneous group of diseases classified by the predominant size, type, and location of involved blood vessels
what are the classic features in a history of a patient with vasculitis?
consider
- age/gender/ethnicity
- drug history
- FH
- symptoms e.g fever, weight loss, malaise, fatigue, appetite
- use glove and sweater approach
- ask about raynauds
- MSK: arthralgia, myalgia, proximal muscle weakness
- CNS/PNS: headaches, visual loss, tinnitus, stroke, seizure, encephalopathy
- nose bleeds, crusts, ulcers
- heart/lung: pericarditis, cough, chest pain, haemoptysis, dyspnea
- GI: abdo pain
- renal: haematuria
- limbs: neuropathy, digital ulcrs/ischaemia
what will be observed in a physical examination of a patient with vasculitis?
- Vital signs: blood pressure (hypertension) and pulse (regularity and rate)
- Skin: palpable purpura, livedo reticularis, nodules, digital ulcers, gangrene, nail bed capillary changes
- Neurologic: cranial nerve exam, sensorimotor exam
- Ocular exam: visual fields, scleritis, uveitis episcleritis
- Cardiopulmonary exam: Crackles, pleural rubs murmurs, arrhythmias
- Abdominal exam: tenderness, organomegaly
what are small vessel vasculitis examples?
- Microscopic polyangiitis (MPA)
- Granulomatosis with polyangiitis (GPA,
formerly Wegener’s granulomatosis) - Eosinophilic granulomatosis with polyangiitis (EGPA; formerly Churg-Strauss syndrome)
- IgA vasculitis (formerly Henoch-Schönlein purpura)
what are medium vessel vasculitis examples?
- Polyarteritis nodosa (PAN)
- Kawasaki disease (KD)
what are large vessel vasculitis examples?
- Takayasu arteritis (TAK)
- Giant cell arteritis (GCA
what can cause secondary vasculitis?
secondary to infections, drugs, malignancy, or connective tissue diseases.
what tests are done to diagnose vasculitis?
also to diagnose any other pathology
- FBC, U&E, LFTs, CRP, PV, ESP
- specific serology: ANA, ANCA, RF
- complement levels C3 and C4
- scrren for Hep B, C and hIV
- serum and urine protein electrophoresis
- Miscellaneous: CK, Blood cultures, ECG
CXR, CT scan, MRI, arteriography and CT-PET may be required to delineate extent of organ involvement.
NB: RENAL INVOLVEMENT IS OFTEN CLINICALLY SILENT. DO URINE DIPSTICK +/- MICROSCOPY TO IDENTIFY UNDERLYING GLOMERULONEPHRITIS
how is vasculitis treated?
General Measures: Rule out infection, stop offending drug in secondary causes
1st line: Corticosteroids
2nd Line: Cytotoxic medications, immunomodulatory, or biologic agents (e.g., cyclophosphamide methotrexate, azathioprine, leflunomide mycophenolate mofetil, rituximab, IVIG.)
