vasculitis part 1 Flashcards
what are the diseases associated with large vessels vasculitis ?
takayasu arteritis
giant cell arteritis
what are the medium vessel vasculitis ?
polyarteritis nodosa
kawasaki disease
what artery is specifically affected in GCA ?
superficial temporal arteries
ophthalmic arteries
what social habit increases the incidence of GCA ?
smoking
what are the clinical features associated with GCA ?
constitutional
headache
temporal tenderness
jaw claudication
visual /ocular symptoms - amaurosis fugax
CNS affection
arterial aneurysms
what is the presentation of polymyalgia rheumatica ?
morning stiffness of more than 45 minutes
sero-negative
pelvic girdle pain and shoulder pain
what disease is associated with GCA ?
polymyalgia rheumatica
what investigations should be done for patients with GCA ?
visual or ocular symptoms - should be assessed
ESR and CRP
temporal artery biopsy ( negative biopsy does not exclude a diagnosis)
what are the histology findings associated with GCA ?
narrowed lumen
giant cells
inflammatory infiltrates
skip lesions
interruption of elastic lamina
what is the management for polymyalgia rheumatica ?
prednisolone 15 mg
bone protection - biphosphonate, calcium and vitamin D
GI protection - PPI
if no improvements reconsideer diagnosis
what is the management of GCA ?
1- prednisolone 40-80 mg ( immediately for eye protection )
40 mg - if no visual symptoms
60-80 mg - if we suspect visual symptoms
2- bone protection ( biphosphonate, calcium and vitamin D)
3- GI protection (PPI)
4- low dose aspirin is usually given to prevent further complications
what is the management of relapses ?
increase dose to previous level or slightly higher
consider steroid-sparing agents like methotrexate
what are the criteria for the diagnosis of takayasu arteritis ?
1- age at disease onset less than 40 years old ( more common in asian women )
2- claudication of the extremities
3- difference of 10 mmhg in systolic blood pressure between thee
arms
4- bruit over one or both subclavian arteries or the abdominal aorta
5- arteriographic narrowing or occlusion
at least 3 of the 6
what are the clinical features of takayasu arteritis ?
early - non-specific, arthritis
late occlusive phase - limb claudication, visual symptoms, HBP, CVA, headache
late complications - CVD and aneurysm
what are the arteriographic changes in takayasu arteritis ?
corckscrew
narrowing irregularity
