Resp 2B

Question 1

What is vasculitis?

What are the different categories for vasculitis and examples for each?

Answer 1

• Inflammation of vessels
• Leads to vessel wall damage –> in turn bleeding, stenosis, ischaemia. Aneurysms can develop around stenosed segments.
• GCA and granulomataosis w polyangitis (GPA) commonest

Categorised by size

• Large –> Dangerous due to risk of impaired blood flow in large vessels. –> GCA and takayasus.
• Medium –> polyarteritis nodosa (PAN) and kawasakis
• Small –> arterioles, venules, capillaries –> immune complex related e.g ANCA, anti GBM

Question 2

What is the generic presentation of vasculitis?

Answer 2

• Purpura. These are purple-coloured non-blanching spots caused by blood leaking from the vessels under the skin.
• Joint and muscle pain
• Peripheral neuropathy
• Renal impairment
• GI –> diarrhoea, abdominal pain and bleeding
• Anterior uveitis and scleritis
• Hypertension

Systemic –> Fatigue, Fever, Weight loss, Anorexia (loss of appetite), Anaemia

Question 3

What are the investigations for vasculitis?

What are the different types of ….. blood tests?

Answer 3

• Inflammatory markers –> CRP and ESR are usually raised in vasculitis.
• Anti neutrophil cytoplasmic antibodies (ANCA) –> blood test to remember for vasculitis.
• There are two type of ANCA blood tests: p-ANCA and c-ANCA.
• P-ANCA are also called anti-MPO antibodies –> microscopic polyangitis, churg strauss.
• C-ANCA are also called anti-PR3 antibodies –> wegeners granulomatosis

Question 4

What is the management for vasculitis?

Answer 4

Depends on type

• Refer to rheumatologist.
• Treatment usually involves a combination of steroids and immunosuppressants.
• Prednisolone –> oral/IV/nasal/inhaled (lung, churg strauss)
• Immunosuppressants –> Cyclophosphamide, Methotrexate, Azathioprine, Rituximab and other monoclonal antibodies
• The management of HSP and Kawasaki disease (the types mainly affecting children) is different.