Vasculitis + temporal arteritis

Question 1

What is the pathology of vasculitis?

Answer 1

Presence of inflammatory leukocytes in vessel wall leading to reactive damage
Loss of vessel integrity, bleeding + lumen compromise = ischemia + necrosis further down

Question 2

What are the types of vasculitis?

Answer 2

Large vessel - Takayasu + GCA
Medium vessel - polyarteritis nodosa + Kawasakis
Small vessel - microscopic polyangitis, GPA, Wegeners, anti-glomerular basement membrane disease
Variable vessel - Behcets + Cogans
Vasculitis associated with systemic disease eg SLE, RA

Question 3

What is GCA?

Answer 3

Type of chronic vasculitis characterised by granulomatous inflammation of walls of medium/ large arteries

Question 4

Complications of GCA

Answer 4

Vision loss
Large artery complications (dissection, aneurysm, stenosis)
CVD
Peripheral neuropathy 
Depression
Confusion 
Deafness

Question 5

How does GCA present?

Answer 5

Relapses common
People >50
New onset, localised headache, unilateral in temporal area

Question 6

What are the other S+S of GCA?

Answer 6

Systemic features (fever, fatigue, weight loss)
Polymyalgia rheumatica 
Scalp tenderness
Intermittent jaw claudication 
Visual disturbances 
Neurological features

Question 7

Initial management of suspected GCA

Answer 7

Temporal artery biopsy 
Oral prednisolone 
Aspirin + PPI
Assess ESR, BP, BM every 3 months 
Osteoporosis prophylaxis may be required