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27 Cards in this Set
- Front
- Back
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Vasculitis: definition
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Inflammation and necrosis of blood vessels:
Dilation/rupture Thrombosis/ischemia Distinct from vasculopathy |
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Vasculitis: Classification
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Large vessel: aorta and branches (Giant cell arteritis)
Medium vessel: muscular arteries, arterioles (classic polyarteritis nodosa) Small vessel: capillaries, venules (Wegener's granulomatosis) |
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Vasculitis:Constitutional symptoms
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Fever, weight loss, anorexia, fatigue
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Vasculitis: Small vessel skin manifestations
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Palpable pupura, urticaria, non-palpable purpura, vesicles/bullae, splinter hemorrhage, superficial ulceration
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Vasculitis: Medium vessel skin manifestations
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Livedo reticularis, nodules, ulcerations, infarcts, gangrene
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Vasculitis: Joint/muscle manifestations
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Arthralgias, arthritis, myalgias+/-weakness
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Vasculitis: Kidney manifestations
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Focal necrotizing glomerulonephritis: hematuria, proteinuria, renal failure, hypertension
Vascular nephropathy (infarcts) |
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Vasculitis: Nervous system manifestations
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Peripheral nerve: mooneuritis multiplex (emergency), polyneruopathy
CNS: stroke, seizure |
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Vasculitis: Heart/lungs manifestations
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Congestive heart failure, myocardial infarction, pericarditis
Pulmonary infiltrates/nodules, pulmonary hemorrhage |
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Vasculitis: GI manifestations
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Bowel ischemia/infarct
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Vasculitis: ENT/eye manifestations
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Episcleritis, orbital pseudotumor, chronic sinusitis, saddle nose deformity
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Vasculitis: other manifestations
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Arm/leg claudication
Jaw claudication Scalp tenderness Testicular pain |
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Vasculitis: Diagnosis
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Bloodwork: Inflammatory markers, organ systems, immune complexes, antibodies (ANCA)
Tissue biopsy Imaging |
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Giant Cell Arteritis: Epidemiology
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Most frequent vasculitis in N.A.
>50yo F>M North to South gradient |
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Giant Cell Arteritis: symptoms and signs
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constitutional symptoms, new onset headache, jaw claudication, shoulder/pelvic pain/stiffness, plymyalgia rheumatica, diploplia, scalp tenderness
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Giant Cell Arteritis: anterior ischemic optic neuropathy (AION)
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End result of untreated giant cell arteritis
Permanent vision loss *must do biopsy promptly to diagnose |
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Giant Cell Arteritis: treatment
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Corticosteroids: 1mo high dose, taper, 1-2 years low dose
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Giant Cell Arteritis: prognosis
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Median survival: 6 years
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Giant Cell Arteritis: complications
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Thoracic aortic aneurysm
Aortic dissection *do yearly CXR to monitor |
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Polyarthritis nodosa: epidemiology
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M=W
40-60yo Hepatitis B a risk factor Rare associations: HIV, CMV, parvovirus B19, HCV |
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Polyarthritis nodosa: Signs and Symptoms
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Weight loss>4kg
Livedo reticularis Myalgias Mononeuritis multiplex Bowel ischemia Renal infarcts |
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Wegener's granulomatosis: organ system's involved
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Pulmonary (major), ENT, renal, skin, nerves
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Wegener's granulomatosis: antineutrophil cytoplasmic antibody formation
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1. Infection causes presentation of cytoplasmic proteins on neutrophil cell surface
2. Antibodies against protiens is made (ANCA) 3. ANCA stimulate neutrophils further |
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Wegener's granulomatosis: diagnosis
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Tissue biopsies:
lungs (open biopsy best): necrosis, vasculitis, granulomas renal: glomerulonephritis, necrosis, pauci-immune, vasculitis (rare), granulomas (rare) |
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Diseases that are positive for ANCA
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Wegener's granulomatosis
Microscopic polyangitis Glomerulonephritis |
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Wegener's granulomatosis: treatment
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Corticosteroids
Immunosuppressive agents: cyclophosphamide, methotrexate, azathioprine, mycophenolate |
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Wegener's granulomatosis: prognosis
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5 year survival = 80-90%
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