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MSK > Vasculitis > Flashcards

Vasculitis Flashcards

1
Q

What is vasculitis?

What causes it?

A

Inflammation of the blood vessels

Autoimmune condition

Med and large generally caused by direct damage

Small generally caused by indirect damage

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2
Q

What condition is commonly mistaken for asthma/allergies?

What can be found on blood samples which explains this?

What kind of vasculitis is this?

A

EGPA (eosinophilic granulomatosis with polyangitits)

High eosinophil count

ANCA +ve small vessel

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3
Q

What are the two types of large vessel vasculitis that you must know?

What differentiates them easily?

A

Giant cell arteritis (GCA)

Takayasu arteritis (TA)

GCA

  • over 50
  • affects carotid -> facial arteries

TA

  • under 50 (most typically asian woman in 20-30)
  • affects aorta and its branches more commonly
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4
Q

What will you find histologically in both forms of large vessel vasculitis?

What would only be found in GCA?

A

Granulomas in internal elastic lamina

Multinucleated Giant cells

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5
Q

Name some general symptoms of vasculitis

A
  • Night sweats
  • Fever
  • Weight loss
  • Malaise
  • Arthlagia

(kinda similar to TB)

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6
Q

What condition can present with a saddle nose deformity (collapse of nasal cartilage)

A

GPA - granulomatosis with polyangitits

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7
Q

What’s the difference in presentation between GPA and microscopic polyangitis?

What’s the difference histologically?

A

Both will affect lungs and kidneys

Only GPA affects nasal and sinus

No granulomas present in microscopic polyangitits

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8
Q

What condition can lung opacities be found in?

How may this condition also present nasally?

A

GPA

Bloody nasal mucus
Chronic sinus pain

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9
Q

What condition leads in 90% of cases to glomerulonephritis?

A

Microscopic polyangitits

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10
Q

Why may a negative biopsy in large vessel vasculitis not rule out the disease?

A

It appears in skip lesions so a -ve biopsy is not able to rule out disease

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11
Q

On bloods what is present in large vessel vasculitis?

A

V. raised ESR

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12
Q

What small vessel condition most commonly presents in middle aged men?

A

GPA

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13
Q

What can be found on CT angiography in large vessel vasculitis?

A

Vessel stenosis

Thickening of vessel walls

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14
Q

How is large vessel vasculitis managed?

A

Prednisolone (40-60mg) and then reduce

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15
Q

How is ANCA +ve small vessel vasculitis managed?

A

Corticosteroids

cyclophosphamide

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16
Q

What is the one ANCA -ve small vessel vasculitis you should know about?

What drives it’s autoimmunity instead?

A

Heinloch-Schonlein purpura (HSP)

IgA

17
Q

Who does HSP more commonly appear in?

How does it present?

How is it managed?

A

More in children

Raised non-blanching purpuric rash on buttocks and legs
Abdo pain and vomitting

Generally following previous URTI few weeks ago

Usually self-resolving

18
Q

What condition may present with SOB and haemoptysis?

A

GPA and microscopic polyangitits

19
Q

What results from kidney damage in GPA and microscopic polyangitits?

A

Increased BP
Decreased urine output

Microscopic polyangitis -> glomerulonephritits

20
Q

What layers of the artery are affected by GCA?

A

All layers (intima, media and adventitia)

21
Q

Describe how GCA may present?

A
  • Continous headache around occipital/ temporal region
  • Jaw claudication (pain after talking too much/chewing - consistent with problem in temporal region)
  • Visual distubrbances
  • Swollen temporal artery
  • Scalp tenderness (noticed when brushing hair)
22
Q

What condition is GCA strongly associated with?

A

PMR - polymyalgia rheumatica

23
Q

How is GCA diagnosed?

A

Temporal artery biopsy

  • mononuclear inflitrations
  • granulomatous inflam
  • giant cells
24
Q

A 55 yo man presents with new onset headache and raised inflam markers, what should be suspected?

A

GCA

25
Q

It is known that in GCA patients can present with visual disturbance. What one of the following is NOT a sign of GCA?

  • Double vision
  • Blurring of vision
  • “Curtain falling down in front of eyes”
A

Blurring of vision

more likely to be a refractory problem

26
Q

What has been shown to prevent visual loss in large cell vasculitis?

A

Steroids

Start straight away once suspect

27
Q

How long do you keep patient on steroid in GCA?

A

18-24months - same as PMR

MSK (41 decks)

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