Vasculitis

Question 1

What is vasculitis?

Answer 1

Vasculitis are inflammatory disorders of blood vessels.

Question 2

What are the types vasculitis?

Answer 2

Large vessel: GCA and Takayasu

Medium vessel: polyarteritis nodusa, Kawasaki disesae

Small vessel (immune complex): Henoch Schonlein purpura

Small vessel (ANCA): microscopic polyangitis, granulomatosis with polyangitis, Chrug-Strauss

Question 3

What is HSP?

Answer 3

An acute, immune complex mediated vasculitis caused by IgA.

Usually follows an URTI

Question 4

What is presentation of HSP?

Answer 4

Purpuric rash on buttocks and thighs.

Arthralgia or arthritis

GI pain

IgA nephropathy

Orchitis

Question 5

What Ix for HSP?

Answer 5

Urinalysis to see renal involvement: protein and blood

Bloods: exclude other causes. May be raised IgA

Question 6

What is management of HSP?

Answer 6

Often self-limiting. Corticosteroids for complications e.g orchitis, torsion, GI disease

5-10% relapse

Question 7

What is polyareritis nodusa?

Answer 7

A necrotising vasculitis that causes aneurysms and thrombosis in medium sized vessels which can cause infarction in affected organs and severe systemic symptoms.

Question 8

What are Sx of polyarteritis nodusa?

Answer 8

systemic features e.g. rash, nodules, renal disease, cardiac, GI, mononeuritis multiplex

Question 9

What Ix in polyarteritis nodusa?

Answer 9

• Raised WCC, mild eosinophilia, anaemia,
  
  • ANCA -ve
  • Renal/mesenteric angiography or renal biopsy can be diagnostic.

Question 10

What Rx in polyarteritis nodusa?

Answer 10

• Control BP

* Steroid for mild and steroid sparing if more severe

Question 11

What is microscopic polyangitis?

Answer 11

Necrotising vasculitis affecting small and medium sized vessels

Causes rapidly progressive GN and pulmonary haemorrhage

Question 12

What Ix in microscopic polyangitis?

Answer 12

pANCA w MPO +ve

Question 13

What is Rx for microscopic polyangitis?

Answer 13

Steroids and methotrexate.

Question 14

What is granulomatosis with polyangitis?

Answer 14

• Characterised by granulomatous necrotising inflammatory lesions of the upper and lower respiratory tract and often a pauci-immune glomerulonephritis

Question 15

What are Sx of granulomatosis with polyangitis?

Answer 15

Upper airway: rhinitis, chronis sinusitis

Lower respiratory: haemorrhage, nodules, cavitation

Renal: GN

Also: nodules on elbows, purpura, pericarditis

Question 16

What Ix in granulomatosis with polyangitis?

Answer 16

cANCA w PR3 +ve

Question 17

What are complications of vasculitis?

Answer 17

End organ damage