Vasculitis

Question 1

What are the types of vasculitis affecting small vessels?

Answer 1

• ANCA associated
  
  • Microscopic polyangiitis
  • Granulomatosis with polyangiitis (Wegener’s granulomatosis)
  • Eosinophilic granulomatosis c polyangiitis (Churg Strauss syndrome)
• IgA
  
  • Henoch-Schonlein purpura
• Immune complex
  
  • Goodpasture’s disease

Question 2

What are the types of vasculitis affecting medium vessels?

Answer 2

• Polyarteritis Nodosa
• Kawasaki Disease
• Churg-Strauss Syndrome

Question 3

What are the types of vasculitis affecting large vessels?

Answer 3

• Giat cell arteritis
• Takayasu’s arteritis

Question 4

What type of vasculitis affects variable vessel sizes?

Answer 4

• Bechet’s
• Cogan’s syndrome

Question 5

What are the generic features of vasculits?

Answer 5

• Purpura
• Joint and muscle pain
• Peripheral neuropathy
• Renal impairment
• Gastrointestinal disturbance
• Anterior uveitis and scleritis
• Hypertension
• Fatigue
• Fever
• Weight loss
• Anorexia (loss of appetite)
• Anaemia

Question 6

What test would you order for vasculitis?

Answer 6

• Inflammatory markers (ESR & CRP)
• ANCA antibodies
  
  • p-ANCA (MPO antibodies): Microscopic Polyangiitis, Churg-Strauss Syndrome
  • c-ANCA (PR3 antibodies): Wegener’s granulomatosis
• Cr
• Urine analysis

Question 7

How would you Mx Vasculitis?

Answer 7

• Large vessels
  
  • Steroids
  • Add steroid-sparing agents later
• Medium/small
  
  • Steroids +
  • cyclophosphamide (if severe) or methotrexate/azathioprine

Question 8

What are the different ways of administering steroids that can be given

Answer 8

• Oral - prednisolone
• IV - hydrocortisone
• Nasal
• Inhaled

Question 9

What medication is given with cyclophosphamide and why?

Answer 9

• Mesna
• cyclophosphamide causes haemorrhagic cystitis

Question 10

What is the alternative name for Wegener’s Granulomatosis?

Answer 10

• Granulomatosis c Polyangiitis

Question 11

What is Granulomatosis c polyangiitis?

Answer 11

• Small vessel vasculitis affecting respiratory tract and kidneys

Question 12

What are the classic symptoms of GPA?

Answer 12

• Upper airways
  
  • saddle-shaped nose
  • epistaxis
  • crusty nose secretion
• Lower airways
  
  • cough, wheeze, haemoptysis
• Kidneys
  
  • Proteinuria
  • Haematuria