Residency Vasculitis Notes

  • Suspect if systemic symptoms
    • arthralgia, more than 1 organ system, fever
    • uveitis
    • rash
    • foot drop, wrist drop
    • polyneuropathy
    • arthritis
    • sinusitis, nose bleed, hemoptysis, asthma
    • kidney disease
  • Classification
    • Large: aorta and branches
    • medium: visceral arteries

Giant Cell

  • Jaw claudication: pain with chewing food
  • 40-50% PMR
  • Anterior ischemic neuritis
  • nl ESR does not rule out
  • steroid 1mg/kg prednisone or 1g methylprednisone x 3 days if blindness or organ damage
  • add methotrexate and vit D to spare steroid
  • biopsy in 2 weeks

ANCA vasculitis

  • Antibody: C = PR3 (antigen), P = MPO (antigen)
  • Wegener: GPA
  • Churg Strauss: EGPA

GPA

  • upper airway, lower airway, renal, neurologic
  • mononeuritis multiplex: foot drop, wrist drop, poly neuropathy
  • variable sx
  • very severe, bloody, black sinusitis
  • cavitary lungs, diffused alveolar hemorrhage

MPA

  • Like GPA without upper airway
  • lower airway and renal

IgA HSP

  • purpura, arthritis, abd pain, preceding viral infection
  • nsaids for arthritis, prednisone for GI
  • mainly supportive

Behcet

  • vein thrombophlebitis, PA aneurysm
  • pathergy: increased immune response to trauma (blood draws, wounds) Behçet syndrome is a form of vasculitis associated with recurrent painful oral and genital ulcerations; patients also may demonstrate additional distinctive features, including hypopyon and pathergy. Central nervous system involvement can manifest as headaches, stroke, and behavioral changes. Gastrointestinal involvement may be hard to distinguish from inflammatory bowel disease. Low-dose prednisone or colchicine is used for oral or genital ulcers, and high-dose prednisone and immunomodulating agents are used for more severe disease. Behçet syndrome does not explain the patient’s fever, hemodynamic instability, pancytopenia, or hepatomegaly, and colchicine therapy is not warranted.

Takayasu

  • pulseless disease
  • 25f asians
  • large artery stenosis
  • immunosupportive, BP control