SM_249a: Vasculitis Flashcards Preview

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Flashcards in SM_249a: Vasculitis Deck (63)
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1

Vasculitides may be classified by ____

Vasculitides may be classified by vessel size

2

Large vessel vasculitis includes ____ and ____

Large vessel vasculitis includes Takayasu arteritis and giant cell arteritis

3

Giant cell arteritis affects ____ ____ most commonly

Giant cell arteritis affects older women most commonly

 

(most common form of arteritis, average onset 73 years, Northern European ancestry)

4

Giant cell arteritis clinical features include ____, ____, ____, ____, ____, and ____

Giant cell arteritis clinical features include new headache, constitutional symptoms, jaw claudication, symptoms of polymyalgia, partial or complete loss of vision, and arm claudication

5

Describe giant cell arteritis diagnostics

Giant cell arteritis diagnostics

  • Laboratory studies: marked elevation in ESR and CRP, thrombocytosis may be seen
  • Imaging: temporal artery ultrasound, MRA, PET
  • Biopsy: temporal artery, should be done urgently on all patients with suspected GCA, yield remains high even after several weeks of treatment

6

____ should be done urgently in all patients with suspected giant cell arteritis

Temporal artery biopsy on the affected side should be done urgently in all patients with suspected giant cell arteritis

7

Giant cell arteritis pathology involves ____, ____, ____, and ____

Giant cell arteritis pathology involves inflammation often centered on internal elastic lamina, multinucleated giant cells, granulomas, and focal fibrinoid necrosis

8

Giant cell arteritis treatment includes ____ and ____

Giant cell arteritis treatment includes high-dose corticosteroids and tocilizumab (anti IL-6)

9

Takayasu arterities is ____ but most commonly affects the ____, ____, or ____ arteries

Takayasu arteritis is a large vessel vasculitis that can affect any artery but most commony affects aorta, subclavia, or carotid arteries

 

(pulmonary artery involvement also common)

10

Takayasu arteritis is characterized by ____, ____, or ____

Takayasu arteritis is characterized by segmental stenosis, dilatation, or aneurysm formation

11

Takayasu arteritis is seen in patients aged ____, ____, and has greatest prevalence in ____

Takayasu arteritis is seen in patients aged ≤ 40 years old, females, and has greatest prevalence in Asia

12

Describe Takayasu arteritis clinical features

Takayasu arteritis clinical features

  • Depend on vascular bed
  • Symptoms to suspect Takayasu arteritis in patient ≤ 40: constitutional symptoms (absent in up to 50% at onset), unexplained lightheadedness, extemity pain / claudication, bruits, or absent/diminished pulses or BP difference > 10 mmHg

13

Takayasu arteritis laboratory findings show ____ and ESR and CRP ____

Takayasu arteritis laboratory findings show no specific lab abnormality and ESR and CRP are often elevated but can be negative despite active disease

14

Takayasu arteritis pathology includes ____, ____, ____, and ____

Takayasu arteritis pathology includes granulomatous panarteritis, intimal hyperplasia, fixed stenosis and occlusions, and occasional aneurysm

15

___ is crucial for Takayasu arteritis diagnosis

Imaging is crucial for Takayasu arteritis diagnosis

 

(noninvasive such as CTA / MRA / PET most common)

16

Describe Takayasu arteritis treatment

Takayasu arteritis treatment

  • High-dose corticosteroids initially: high relapse rate if tapered
  • Methotrexate or azathioprine are preferred steroid-sparing agents to help maintain remission
    Surgical bypass with good results in certain specific situations
  • Angioplasty ± stenting has generally been associated with high failure rates
  • Early recognition and initiation of therapy are critical because aortic regurgiation and acute MI are common and can cause death

17

Compare and contrast giant cell arteritis and Takayasu arteritis

Gziant cell arteritis and Takayasu arteritis

18

Medium sized vasculitides include ____ and ____

Medium sized vasculitides include polyarteritis nodosa and Kawasaki disease

19

Polyarteritis nodosa is ____, more common in ____, and typically presents between ages ____

Polyarteritis nodosa is a systemic necrotizing vasculitis of medium-sized muscular arteries (often at branch points), more common in males, and typically presents between ages 40-60

 

(but can affect any age group, primary or secondary)

20

Secondary polyarteritis nodosa is primarily associated with ____

Secondary polyarteritis nodosa is primarily associated with HBV

 

(also HCV, HIV, hairy cell leukemia)

21

Polyarteritis nodosa involves ____, ____, and ____

Polyarteritis nodosa involves transmural inflammation, no giant cells or granulomas, and often dfiferent phases of vasculitis occurring within different vessels or one vessel at the same time

22

Polyarteritis nodosa clinical features include ____, ____, ____, ____, ____, and ____

Polyarteritis nodosa clinical features include cutaneous, renal disease (not glomerular), neuropathy, mesenteric ischemia, orchitis, and myalgia/weakness

 

  • Cutaneous: nodules, purpura, livedo reticularis, ulcers

23

Describe polyarteritis nodosa treatment

Polyarteritis nodosa treatment

  • Mild: glucocorticoid monotherapy, methotrexate or azathioprine for resistant disease
  • Moderate to severe: glucorticoid and cyclophosphamide
  • Viral associated secondary polyarteritis nodosa: check for HBV, appropriate antiviral therapy (± glucocorticoids and/or immunosuppression)

24

Kawasaki disease is ____ and that is more common in ____ ____

Kawasaki disease is an acute febrile typically self-limited vasculitis seen in young children that is more common in Asian boys

 

(#1 cause of acquired heart disease in kids, presents betwen 6 months and 5 years of age)

25

Kawasaki disease clinical manifestations include ____ and ____

Kawasaki disease clinical manifestations include strawberry tongue and erythematous rash

26

Kawasaki disease pathology primarily affects ____ and includes ___, leading to ___

Kawasaki disease pathology primarily affects medium-sized muscular arteries (coronary arteries) and includes destruction of luminal endothelial cells, elastic lamina, and smooth muscle cells of media, leading to arterial wall dilatation ± aneurysm formation

27

Kawasaki disease laboratory finds are ____ and include ____, ____, and ____

Kawasaki disease laboratory finds are generally nonspecific and include leukocytosis with left shift, normocytic anemia and often marked thrombocytosis, and transaminitis or mild hyperbilirubinemia due to intrahepatic congestion

28

Kawasaki disease treatment includes ____ and ____

Kawasaki disease treatment includes aspirin and IVIG

 

  • Aspirin: initially high-dose until fever resolves, anti-thrombotic dose continued for 6-8 weeks or until lab abnormalities resolve and there are no coronary abnormalities on echo
  • IVIG: significant reduction in risk of mortality related to coronary artery aneurysms if begun within 1st 10 days

29

ANCA-associated small vessel vasculitis includes ____, ____, and ____

ANCA-associated small vessel vasculitis includes microscopic polyangiitis, granulomatosis with polyangiitis, and eosinophilic granulomatosis with polyangiitis

30

____ is associated with p-ANCA while ____ is associated with c-ANCA

MPO is associated with p-ANCA while PR3 is associated with c-ANCA

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