Vasculitis - booklet Flashcards
What is vasculitis?
Inflammatory blood vessel disroder
Clinical features result from damage to blood vessel walls with subsequent thrombosis, ischaemia, bleeding and or aneurysm formation
How is vasculitis classed?
- Size - large medium or small vessels
- Type
- Location of blood vessels involed
History for vasculitis
- Age, gender, ethnicity
- Drug history
- FH
- Constutional symptoms - fever, weight loss, malaise, fatigue, diminished appetite, sweats
- Glove and sweater approach
Glove adn sweater approach
- Raynauds
- MSk - arthralgia, myalgia, proximal muscle weakness
- CNS/PNS - headaches, visual loss, tinnitus, stroke, seizure, encephalopathy
- Nose bleeds, crusts, ulcers, oral ulcers
- Heart/lung - pericarditis, cough, chest pain, haemoptysis, dyspnoea
- GI abdominal pain
- Renal - haematuria
- Limbs - neuropathy, digital ulcers/ischaemia
Physical exam for vasculitis
- BP and pulse
- Skin - palpable purpura? nodules? digital ulcers, gangrene, nail bed capillary changes
- CN exam
- Sensorimotor exam
- Ocular exam - visual fields, sceritis, uveitis, episleritis
- CVs and Pulmonary exam - crackles, pleural rubs, murmurs, arrhythmias
- ABdo - Tenderness or organomegally
Small vessel vasculitis types
- Microscopic polyangitis (MPA,)
- Granulomatosis with polyangitis (GPA formerly Wegeners)
- Eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome)
- IgA vasculitis (Henoch-Schonlein)
Medium vessel vasculitis
- Polyarteritis nodosa (PAN)
- Kawasaki disease (KD)
Large vessel arteritis
- Takayasu arteritis (TAK)
- Giant cell arteritis (GCA)
Is vasculitis primary or secondary?
Can be either
Secondary causes inc:
* Infections
* Drugs
* Malignancy
* CT diseases
Secondary more common than primary
Renal involvement in vasculitis
- Clinically SILENT
- Need urine dipstick +/- microscopy to identify glomerulonephritis
Initial tests for vasculitis
Exclude alternative diagnosis:
* FBC, U&E, LFT, CRP, PV, ESR
* Serology
* Complement - C3 and C4
* Hepatitis B&C
* HIV
* Cryoglobulins
* Serum and urine protein electrophoresis
Serology for vasculitis
- ANA
- ANCA
- RF
Random tests depending on presentation for vasculitis
- CK
- Blood cultures
- ECG
- CXR
- CT scan
- MRI
- Arteriography and CT PET to show extent of organ involvement
Treatment for vasculitis
- Rule out infection
- Stop offending drugs
- 1st line - corticosteroids
- 2nd - cytotoxic medications, immunomodulatory or biologics eg cyclophosphamide, methotrexate, azathioprine, leflunomide, mycophenolate mofetil, rituximab, IVIG
What can present with a vasculitis like syndrome?
Atrial myxomas - ECHO can exclude this
