Vasculitis Flashcards
What is vasculitis?
A group of inflammatory blood vessel disorders.
There is damage of the blood vessel walls with subsequent thrombosis, ischaemia, bleeding and/or aneurysm formation.
What classifications of vasculitis are there?
Small vessel vasculitis
Medium vessel vasculitis
Large vessel vasculitis
Examples of large vessel vasculitis.
Giant cell arteritis
Takayasu’s arteritis
Examples of medium vessel vasculitis.
Classical polyarteritis nodosa (PAN)
Kawasaki’s disease
Examples of small vessel vasculitis.
ANCA-associated;
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
ANCA-negative;
IgA vasculitis (Henoch-Schönlein)
Cutaneous leucocytoclastic vasculitis
Essential cryoglobulinaemia
What is Takayasu’s arteritis?
A large vessel vasculitis that is rare except in Japan.
It is known as the pulseless disease or aortic arch syndrome.
Occurs predominantly in females.
Age of 40 years with non-specific systemic symptoms, such as fever, malaise and muscle aches, or with more specific symptoms of arm claudication or syncope.
It is diagnosed using CT or MRI angiography. Doppler ultrasound of the carotids can be useful in detecting carotid disease.
Vasculitis of the aortic arch as well as other major arteries.
Corticosteroids only help the constitutional symptoms.
Heart failure and stroke will follow.
Difference between GCA and Takayasu’s.
What is polyarteritis nodosa.
A rare condition that usually occurs in middle-aged men.
Severe systemic manifestations that is occassionally associated with Hep B.
This suggests that it is secondary to deposition of immune complexes.
Causes renal impairment, strokes and MIs.
Associated with a rash called livedo reticularis.
Clinical features of Polyarteritis Nodosa.
Fever
Malaise
Weight loss
Fever
Mononeuritis multiplex
Abdominal pain mimicking acute cholecystitis, pancreatitis or appendicitis.
Haematuria and proteinuria
Coronary arteritis
Subcut haemorrhage
Investigations in polyarteritis nodosa.
Bloods - anaemia, leucocytosis and raised ESR
Biopsy showing fibrinoid necrosis of vessel walls with microaneurysm formation.
Angiography showing microaneurysms
USS or ECG.
Treatment of Polyarteritis Nodosa.
Control BP and refer.
Steroids for mild cases and steroid sparing agents if more severe.
Hep-B should be treated after initial treatment with steroids.
What is Kawasaki’s disease?
An acute systemic vasculitis involving medium-sized vessels.
It happens in children under 5 years old with an infective trigger.
Clinical features of Kawasaki’s.
Fever lasting longer than 5 days
Bilateral conjunctivitis
Dry red lips
Cervical lymphadenopathy
Erythematous rash
Strawberry tongue
Treatment of Kawasaki’s
Aspirin + IV immunoglobulins according to Zero To Finals
Coronary artery aneurysm is a key complication
General history to ask about vasculitis.
Consider age, gender and ethnicity.
Drug history
FH of vasculitis
Constitutional symptoms such as fever, weight loss, malaise, fatigue, diminshed appetite and sweats.
Explain granulomatosis polyangiitis.
Wegener’s granulomatosis is a small vessel vasculitis. It affects the respiratory tract and kidneys.
Epistaxis and crusty nasal secretions
Hearing loss
Sinusitis
Saddle shaped nose
In the lungs it causes a cough, wheeze and haemoptysis.
A chest xray may show consolidation and it may be misdiagnosed as pneumonia.
In the kidneys it can cause a rapidly progressing glomerulonephritis.
