Vasculitis - General

Question 1

What are the 2 main types of vasculitis?

Answer 1

Primary

Secondary

Question 2

What are the 4 main causes of secondary vasculitis?

Answer 2

Infection
Underlying disease
Cold injury
Drugs

Question 3

What are the 3 main types of primary vasculitis?

Answer 3

Large vessel vasculitis
Medium vessel vasculitis
Small vessel vasculitis

Question 4

What are the 2 main types of large vessel vasculitis?

Answer 4

Giant cell vasculitis (temporal arteritis)

Takayaku’s disease

Question 5

What are the 2 main types of medium vessel vasculitis?

Answer 5

Polyarteritis nodosa

Kawasaki’s disease

Question 6

What are the 2 main types of small vessel vasculitis?

Answer 6

Immune complex mediated vasculitis

ANCA positive vasculitis

Question 7

What are the 2 types of ANCA positive vasculitis?

Answer 7

c-ANCA positive vasculitis

p-ANCA positive vasculitis

Question 8

Give 1 example of a c-ANCA positive vasculitis.

Answer 8

Wegener’s granulomatosis

Question 9

What are the 2 types of p-ANCA positive vasculitis?

Answer 9

MPO positive vasculitis

MPO negative vasculitis

Question 10

List 3 examples of MPO positive (p-ANCA) vasculitis.

Answer 10

Microscopic polyangiitis
Churg-Strauss syndrome
Crescentic GN/RPGN

Question 11

List 3 examples of MPO negative (p-ANCA) vasculitis.

Answer 11

RA
IBD
Sclerosing cholangitis

Question 12

Give 4 examples of infections which might cause secondary vasculitis.

Answer 12

Meningococcus
Streptococcus
Erythema nodosum
Hepatitis B/C

Question 13

When would you suspect vasculitis to be secondary to infection? (2)

What are the features of meningococcal vasculitis, for example? (2)

Answer 13

WHEN TO SUSPECT INFECTION:
Other signs of infection present
Short history of vasculitis

MENINGOCOCCAL VASCULITIS:
Purpura
Purpura fulminans (tissue infarction)

Question 14

Give 2 examples of underlying disease which could cause secondary vasculitis.

Answer 14

Cancer

Autoimmune disease

Question 15

List 2 types of cold injury which could cause secondary vasculitis.

Answer 15

Frostbite

Cryoglobulinaemia

Question 16

Describe the pathophysiology of cryoglobulinaemia. (3)

Answer 16

1. Autoantibody production is stimulated by the cold
2. Autoantibodies cause an acute inflammatory response in small blood vessels
3. This makes RBCs agglutinate (stick together)
   a. This causes blockage of small vessels
   b. This causes tissue infarction

Question 17

Give 3 examples of drugs which could cause secondary vasculitis.

Answer 17

Carbimazole
Panicillin
Other antibiotics

Question 18

Describe the clinical features of primary vasculitis. Consider:

a) Inflammatory features. (5)
b) Features of large vessel vasculitis. (3)
c) Features of small vessel vasculitis. (3)

Answer 18

INFLAMMATION:
Fever
Weight loss
Malaise
Myalgia
Night sweats

LARGE VESSELS:
End organ ischaemia/infarction
Arterial stenosis
Hypertension (due to activation of RAS system in kidneys)

SMALL VESSELS:
Inflammation
Purpura
Glomerulonephritis

Question 19

Describe the clinical features of vasculitis in veins. (1)

Answer 19

Bechet’s disease

“an idiopathic disease of the immune system characterised by genital/mouth ulcers, skin lesions and severe uveitis; may also involve joints and veins”

Question 20

What investigations would you do for vasculitis? (11)

HINT: split them up into 4 groups.

Answer 20

BLOODS:

• FBC
• CRP/ESR
• U&Es
• LFTs
• ANCA levels

OBSERVATIONS:

• Temperature
• Height/weight/BMI

EXAMINATION:

• Vascular system (incl. pulses, aneurysms)
• BP (in all 4 limbs)

IMAGING:

• Angiography
• Biopsy