Vasculitits Flashcards
What is giant cell arteritis?
A Vasculitis of a large. Blood vessel called the temporal artery
What rheumatological condition is heavily linked to giant cell arteritis?
Poly myalgia rheumatica
What is the key complication of giant cell arteritis?
Irreversible vision loss/blindness
What is the characteristic presentation of giant cell arteritis/temporal arteritis?
Unilateral severe headache around the temple and forehead with:
-scalp tenderness
-jaw claudication
-blurred or double vision
-loss of vision
What systemic symptoms might present with giant cell/temporal arteritis?
Polymyalgia rheumatica symptoms (stiffness of shoulder and pelvic girdle with pain)
Weight loss
Fatigue
Low grade fever
Muscle tenderness
Carpal tunnel sydnrome
Peripheral oedema
How is temporal arteritis/giant cell arteritis diagnosed/investigated?
Clinical presentation
Raised inflammatory markers (CRP, ESR)
Duplex ultrasound of temporal artery
Temporal artery biopsy
What would the duplex ultrasound of the temporal artery shows in a case of giant cell arteritis?
Hypoechoic halo sign and stenosis
What would the temporal artery biopsy reveal if the patient has giant cell arteritis ?
Multinucleated giant cells
What type of medication is given to treat giant cell arteritis?
Steroids
What does the management of giant cell arteritis depend on?
Whether there is visual symptoms or jaw claudication
What is the management of giant cell arteritis if there are NO visual symptoms or jaw claudication?
40-60mg Prednisolone
What is the management of giant cell arteritis which involve visual symptoms or jaw claudication?
500mg-1000mg methyl Prednisolone daily
What medications are given for the long term management of giant cell arteritis?
Wean down steroids until on nothing usually 1-2years
Bisphosphonates like allendronic acid for bone protection
Vitamin D
Calcium
Aspirin 75mg daily (decreases vision loss and strokes)
What specialties deal with giant cell arteritis?
Rheumatology (specialist diagnosis and management)
Vascular surgeons (temporal artery biopsy)
Ophthalmology (visual symptom review)
What are the complications of steroids?
Weight gain
Hypertension
Purple striae
T2DM
CVA
Peptic ulcers
Osteoporosis
Muscle weakness
Recurrent infection s
What are some vasculitis disease affecting small blood vessels?
Henoch-Schonlein purpura)
Microscopic polyangiits
Granulomatosis
Granulomatosis with polyangitis (Wegners granulomatosis)
What are some Vasculitis that affect large blood vessels?
Giant cell arteritis
Takayasu’s arteritis
What are some common features of vasculitis?
Joint and muscle pain
Peripheral neuropathy
Renal impairment
Purpura
Necrotic skin ulcers
GI symptoms
B-symptoms
What are some systemic B symptoms associated with Vasculitis?
Fatigue
Fever
Night sweats
Weight loss
Anorexia
Anaemia
What medications are given to treat Vasculitis ?
Steroids
They are administered to the affected areas
What investigations are done if you suspect a vasculitits?
Inflammation markers (CRP and ESR)
p-ANCA
c-ANCA
What is Henoch-Schonlein Purpura?
An IgA vasculitis that commonly occurs in kids 1-3 days after and upper respiratory tract infection (IgA depsoited in the blood vessels)
What are the features of Henoch Schonlein purpura?
Purpura
Joint pain
Abdominal pain
Renal involvement (IgA nephritis)
How is Henoch-Schonlein purpura managed?
Supportive (analgesia, rest, hydration)
Urine dip to monitor for renal involvement
BP monitoring for HTN
What is microscopic polyangitis?
How does it present?
Small vessel Vasculitis
Glomerulonephritis
Diffuse alveolar haemorrhage
(Haematuria + Haemoptysis)
What investigation would be positive with microscopic polyangitis?
Nasal steroids
Inhaled
What is granulomatosis with polyangitis/ Wegners Granulomatosis?
What is its characteristic presentation?
Small vessel Vasculitis
Affects respiratory tract and kidneys
Epistaxis
Hearing loss
Sinusitis
What is a classic sign of Wegners granulomatosis/ granulomatosis with polyangitis?
Saddle-shaped nose
How is granulomatosis with polyangitis managed?
Inhaled and nasal steroids
Oral steroids for kidneys
What investigation would be positive with granulomatosis with polyangitis/Wegners granulomatosis?
C-ANCA
What is eosinophilic granulomatosis with polyangitis?
Small vessel Vasculitis affecting the lungs and skin mainly but can involve the kidneys
How does Eosinophilic granulomatosis with polyangitis?
Severe asthma in middle age
Sinusitis
Allergic rhinitis
Raised eosinophils
What investigation is elevated with eosinophilic granulomatosis with polyangitis?
P-ANCA
What is the management for eosinophilic granulomatosis with polyangitis?
Inhaled steroids
What is Takayasus Arteritis?
Large vessel vasculitis affected the Aorta and its branches (can also affect the pulmonary arteries)
How does takayasus arteritis present?
Fever
Malaise
Muscle aches
Claudication symptoms of the affected limb
Pulselessness disease (stenosis or occlusion of affected vessel)
How is takayasus arteritis diagnosed?
CT or MRI angiogram
What vasculitis conditions have a positive c-ANCA?
Wegners granulomatosis/granulomatosis with polyangitis
What Vasculitis conditions have a positive p-ANCA?
Microscopic polyangitis
Eosinophilic granulomatosis with polyangitis
What medication can a patient not have if they are allergic to aspirin?
Sulfasalazine
