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21 Cards in this Set
- Front
- Back
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What are the two large vessel vasculitides?
Two medium vessel vasculitides? |
Large: Takayasu's and temporal arteritis
Medium: PAN and Kawasaki's |
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Small vessel vasculitides are divided into two groups. Give the groups and the individual diseases.
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Immune-complex:
Hypersensitivity vasculitis HSP Cryoglobulinemic ANCA (paucimmune) Wegener's Churg-Strauss Microscopic polyangiitis |
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What vasculitis is suggested by:
sinus involvement? bloody diarrhea? |
sinus: Wegener's; also Churg-Strauss
bloody diarrhea: HSP |
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What vasculitis is suggested by:
testicular tenderness? mononeuritis multiplex? |
testicular tenderness: PAN
mononeuritis: PAN, Wegener's, Churg-Strauss |
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Why is albumin low in vasculitis?
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Albumin in a NEGATIVE acute phase reactant, which goes down with systemic inflammation.
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What test is highly specific for Wegener's?
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c-ANCA, against proteinase 3
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You find positive cryoglobulinemia in labs. What next?
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rule out hepatitis C.
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What vasculitides have low complement?
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Cryoglobulinemia, nearly always
PAN in 25% of cases occasionally in hypersensitivity vasculitis. |
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p-ANCA against myeolperoxidase suggests what two vasculitides?
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Churg-Strauss, microscopic polyangiitis
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What if you have p-ANCA but not against myeloperoxidase?
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Consider inflammatory bowel disease, infection, and other systemic inflammatory conditions besides vasculitis.
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What are the most sensitive exam findings for temporal arteritis?
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scalp tenderness
reduction in TA pulse + tenderness visual abnormalities are less sensitive, but must be acted upon always check for jaw claudication too |
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What is the treatment for temporal arteriitis?
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high dose prednisone 20 mg 3 x per day
treatment continues for SIX MONTHS at least, and low dose maintenance may be needed after that; tapering usually begins after ESR is normalized (down 5 mg Q 1-2 weeks to 30 mg once a day) Alternate day regimens DO NOT WORK |
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Epidemiology of Takayasu's arteriitis
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girls and young women 10-30
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Clinical features of Takayasu's arteriitis
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Bruits #1 (80%)
upper extremity claudication decreased upper extremity pulses asymmetric blood pressure note that there are nonspecific symptoms in the early stage: fever, arthralgia, weight loss; patients under 20 will often present in this stage. |
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Treatment of Takayasu's arterittis
Treatment for relapsing Takayasu's |
Same as for temporal arteriitis:
high dose prednisone, 20 mg 3 times per day Methotrexate for relapsing condition; also mycophenolate, cyclophosphamide |
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What are the most common organ symptoms of PAN?
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>50%: focal necrotizing glomerulonephritis
severe hypertension (due to GN) mononeuritis muliplex 50%: myalgia, arthralgia palpable purpura, livedo <30% liver function abnormalities abdominal pain testicular pain more rare: |
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T/F: PAN will usually show thrombocytosis and low albumin.
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true.
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How is PAN diagnosed?
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tissue biopsy if possible (sural nerve, liver, rectum, testicle)
if affected area cannot be biopsied, visceral angiogram |
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What disease conditions are associated with PAN?
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HEPATITIS B
Other viruses: CMV, EBV, parvovirus Autoimmune disorders: RA, SLE, PM-DM medications: sulfa, allopurinol Hairy cell leukemia |
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How is PAN treated?
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if no Hepatitis B:
high dose corticosteroids (prednisone, or if severe, methylprednisone) Cyclophosphamide or other cytotoxics are added if there is major organ involvement if Hepatitis B, steroids alone allow virus to persist, so add: plasmapheresis to remove immune complexes, antivirals against hep B: interferon-2a, lamivudine |
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Can Buerger's disease affect patients who chew tobacco or smoke pipes?
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yes.
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