7- Epidemiology and risk factor, screening, prevention and conservative treatment of arterial diseases – vasculitis

define vasculitis

• inflammation of vessel wall → ischemia + damage to the organs supplied by these vessels

what is it classified based on

• based on size of vessels affected

  • large, medium, small

what are the types of vasculitis

• infectious

• non infectious- immune mediated

describe infectious vasculitis

• localised vasculitis due to direct invasion or arteries by infectious agents
  • bacteria and fungi- aspergillus spp or mucor spp
• infections cause weakening of arterial walls → mycotic aneurysms/ thrombosis → infarction

describe non infectious vasculitis

• immune based disease → autoimmune disease

what are the immunological mechanisms that start non infectious vasculitis

• type 3 hypersensitivity- immune complexes
• anti neutrophilic cytoplasmic antibodies- ANCA
• antibodies against endothelial cells
• cell mediated immunity

name the large vessel vasculitis

• giant cell (temporal) vasculitis
• takayasu’s arteritis

what is giant cell vasculitis

• affects temporal artery of the head, but also opthalmic + vertebral arteries
  • → blindness if opthalmic
• inn older >50s
• if chronic granulomatous reaction around the vessels → narrowing of the lumen → shortage of blood vessels

what are the features of giant cell vasculitis

• headavhe
• visual disturbances/ loss
• jaw claudication
• flu like symptoms

how do you diagnose giant cell vasculitis

• temporal artery biopsy is diagnosed→ can be normal due to segmental involvement!
• high inflammatory markers

what is the treament of giant cell vasculitis

• corticosteroids

what is takayasu’s arteritis

• granulomatous vasculitis involves the aortic arch and its branches → fibrosis → narrowing + obliteration of origin of great vessels
• in adutls Under 50yo, mostly in asia

what are the features of takayasu’s arteritis

• pulseless disease- weaker pulse in upper extremities
• retinal haemorrhage → blindness
• neurological consequences → paresis/ weakening of muscles

how do you diagnosis of takayasu’s arteritis

• imaging demonstrates stenosis, occlusions and/or aneurysms of aorta and its branches
  • MRA, CT angiography, US

what is the treatment of takayasu’s arteritis

• corticosteroids

what are the medium sized vasculitis

• polyarteritis nodosa
• Kawasaki disease
• Buerger’s disease

what is polyarteritis nodosa

• polyarteriris= all vessels are affected
• nodosa= segmental
• characterised by necrotising inflammation (due to IC deposition)
• seen more in renal, coronary, hepatic, mesenteric arteries
• occurs in young adults and elderly people

what are the features of polyarteritis nodosa

• kidney failure
• HT
• MI
• abdominal pain with melena
• skin lesions

how do you diagnose polyarteritis nodosa

• biopsy → P ANCA +

what is the treatment of polyarteritis nodosa

• corticosteroids + cyclophosphamide

what is Kawasaki disease

• mucocutaneous lymph node syndrome
• affects children younger than 4yo, endemic in japan
• affects the coronaries and mucocutan arteries
  • due to production of anti endothelial cell antibodies

what are the features Kawasaki disease

• mucocutan
  • erythematous rash of palms and soles, cervical LN enlargement, oedeoma of hands + feet
• coronaries
  • thrombosis with MI, aneurysm with rupture

what is the treatment of Kawasaki disease

• IV Ig and aspirin

what is Buerger’s disease

• thromboangitis obliterans
• segmental thrombosing inflammation of both and medium sized arteries
• occurs almost exclusively in smokers
• sttarts before 35yo

what are the features of Buerger’s disease

• necrosis + gangrene of extremities → risk of amputation
• pain due to neural involvement
• superficial nodular phlebitis- vein inflammation

what is the treatment of Buerger’s disease

• smoking cessation

what are the small sized vessel vasculitis

• Wegener granulomatosis
• microscopic polyangitis

what is Wegener granulomatosis

• necrotising vasculitis
• triad characteristics:
  • necrotising granuloma of the upper and lower respiratory system
  • necrotising vasculitis of small and medium sized vessels
  • necrotising GN

what are the features of Wegener granulomatosis

• sinusitis, nasopharyngeal ulceration, haemoptysis
• hematuria due to GN

how do you diagnose Wegener granulomatosis

• biopsy- C ANCA

what is the treatment of Wegener granulomatosis

• steroids

what is microscopic polyangitis

• necrotising vasculitis of arterioles, venules and capillaries → multiple organs

what are the features of microscopic polyangitis

• hemoptysis, hematuria, abdominal pain, purpura

how do you diagnose microscopic polyangitis

• P ANCA +

what is the treatments pf microscopic polyangitis

• corticosteroid