Vasculitis Flashcards
What is vasculitis?
What causes it?
Inflammation of the blood vessels
Autoimmune condition
Med and large generally caused by direct damage
Small generally caused by indirect damage
What condition is commonly mistaken for asthma/allergies?
What can be found on blood samples which explains this?
What kind of vasculitis is this?
EGPA (eosinophilic granulomatosis with polyangitits)
High eosinophil count
ANCA +ve small vessel
What are the two types of large vessel vasculitis that you must know?
What differentiates them easily?
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
What will you find histologically in both forms of large vessel vasculitis?
What would only be found in GCA?
Granulomas in internal elastic lamina
Multinucleated Giant cells
Name some general symptoms of vasculitis
- Night sweats
- Fever
- Weight loss
- Malaise
- Arthlagia
(kinda similar to TB)
What condition can present with a saddle nose deformity (collapse of nasal cartilage)
GPA - granulomatosis with polyangitits
What’s the difference in presentation between GPA and microscopic polyangitis?
What’s the difference histologically?
Both will affect lungs and kidneys
Only GPA affects nasal and sinus
No granulomas present in microscopic polyangitits
What condition can lung opacities be found in?
How may this condition also present nasally?
GPA
Bloody nasal mucus
Chronic sinus pain
What condition leads in 90% of cases to glomerulonephritis?
Microscopic polyangitits
Why may a negative biopsy in large vessel vasculitis not rule out the disease?
It appears in skip lesions so a -ve biopsy is not able to rule out disease
On bloods what is present in large vessel vasculitis?
V. raised ESR
What small vessel condition most commonly presents in middle aged men?
GPA
What can be found on CT angiography in large vessel vasculitis?
Vessel stenosis
Thickening of vessel walls
How is large vessel vasculitis managed?
Prednisolone (40-60mg) and then reduce
How is ANCA +ve small vessel vasculitis managed?
Corticosteroids
cyclophosphamide
What is the one ANCA -ve small vessel vasculitis you should know about?
What drives it’s autoimmunity instead?
Heinloch-Schonlein purpura (HSP)
IgA
Who does HSP more commonly appear in?
How does it present?
How is it managed?
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
What condition may present with SOB and haemoptysis?
GPA and microscopic polyangitits
What results from kidney damage in GPA and microscopic polyangitits?
Increased BP
Decreased urine output
Microscopic polyangitis -> glomerulonephritits
What layers of the artery are affected by GCA?
All layers (intima, media and adventitia)
Describe how GCA may present?
- 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)
What condition is GCA strongly associated with?
PMR - polymyalgia rheumatica
How is GCA diagnosed?
Temporal artery biopsy
- mononuclear inflitrations
- granulomatous inflam
- giant cells
A 55 yo man presents with new onset headache and raised inflam markers, what should be suspected?
GCA
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”
Blurring of vision
more likely to be a refractory problem
What has been shown to prevent visual loss in large cell vasculitis?
Steroids
Start straight away once suspect
How long do you keep patient on steroid in GCA?
18-24months - same as PMR
