Vasculitis Flashcards
Name examples of large vessel vasculitis?
Giant cell arteritis
Takayasu’s arteritis
Name some examples of medium vessel vasculitis?
Polyarteritis nodosa
Kawasaki disease
Name some examples of small vessel arteritis?
ANCA-associated vasculitis
Microscopic polyangiitis
Churg-Strauss syndrome (Eosinophilic granulomatosis with polyangiitis
Goodpastures disease (Immune complex vasculitis)
What is the management for large vessel vasculitis?
Steroids. You can add steroid sparing agents later on into the treatment.
What is the management for small vessel vasculitis?
Steroids+/- another agent.
Cyclophosphamide if severe, methotrexate/azathioprine depending on the features.
What condition is Giant Cell Arteritis (Temporal Arteritis) heavily associated with?
Polymyalgia Rheumatica
What are the symptoms of GCA?
Scalp pain - pain on brushing/combing hair
Pain over the temporal artery
Jaw claudication
Amaurosis fugax or sudden unilateral blindness
What abnormal blood results would you expect from a patient with GCA?
High ESR
High platelets
High CRP
High ALP
Low Hb
What is the management of GCA?
Refer for an urgent Rheumatology appointment
Temporal artery biopsy should be carried out within 14 days of presentation
Prednisolone PO 60mg/day started immediately
Consider IV methylprednisolone if there is a history of evolving vision loss or amaurosis fugax
When should steroid treatments be stopped in a patient with GCA?
Reduce the dose when symptoms have resolved and their ESR is normal.
Increase the dose if the patient gets a relapse
Condition usually happens over the course of 2 years - can stop medication at this point if symptoms have resolved.
What medications should you prescribe alongside a long term steroid treatment?
Bisphosphonate - eg. Alendronic acid
PPI
Calcium tablets with colecalciferol.
Consider Aspirin
How does Polymyalgia Rheumatica usually present?
In patients >50 years old with bilateral muscle aches, proximal limb muscles usually affected.
Patients can have mild poly arthritis
Morning stiffness in the joints
Fever, weight loss, fatigue and depression can also present.
What abnormal blood results would you expect to see in a Polymyalgia Rheumatica patient?
Elevated CRP
High AlkP in 30% patients
ESR can be high
CK levels normal - determines from a polymyositis/dermatomyositis
How do you manage Polymyalgia Rheumatica?
Prednisolone 15mg/day PO. A dramatic response should be expected within a week or you should be considering another diagnosis.
Reduce the dose of prednisolone by 1mg/month according to symptoms/ESR. Most patients will need steroids > 2 years so bone protection should be given.
