00:00
So here is an overall classification
of vasculitis.
00:06
You'll notice that there are primary
vasculitis syndromes
and there are secondary vasculitis
syndromes,
we're not going to talk
in this presentation
about the secondary ones
because they've already been discussed
under various diseases.
00:25
So, for example, lupus
erythematosus often has vasculitis
and there's a discussion
under that entity of the vasculitis,
rheumatoid arthritis
and and the sarcoidosis.
00:38
Similarly also can result in vasculitis.
00:43
And again, under those entities,
you will see discussions on the vasculitis
and then sometimes they're not uncommon.
00:50
As drug induced vasculitis, hepatitis B
or C can be associated with vasculitis.
00:57
Some forms of cancer
can be associated with vasculitis,
and he knocks line purpura as well.
01:04
So those are all separate entities
discussed in a separate
lecture by Lecturio.
01:12
We're going to talk about the primary
forms of vasculitis.
01:19
It comes in three forms
small vessels, medium size vessels
and medium to large sized vessels,
and we'll start with the small vessel
vasculitis syndromes.
01:32
So. Let's take the first one,
this one, so-called granulomatosis
with polyangiitis that means
multiple vessels with granulomas in them
used to be called Wegner's.
01:46
It was named after a physician, Wegner,
who turned out to have done
some rather immoral things.
01:53
And so his name has been stricken
from this syndrome.
01:56
It's now called granulomatosis
with polyangiitis.
02:01
It's this granulomatous inflammation
of small vessels, as we said.
02:06
The mean age of onset is around 40 years.
02:09
It affects the upper airways,
often is diagnosed
initially as sinusitis
and patients are treated with antibiotics
and the lungs are involved
in a high percentage of cases.
02:22
And there can be infiltration of the lungs
with nodules and hemoptysis.
02:26
75% also involve the kidneys
with with an immune form
of glomerulonephritis.
02:34
It can also involve multiple other organs,
the eyes, skin, joints and so forth.
02:39
And sometimes a rash that gets biopsied
is a clue to what's going on.
02:45
The diagnosis, again, is from biopsy,
often
in the sinus or the nasal passages,
and the biopsy shows granuloma
granulomas
or we're in the vascular inflammation.
02:59
There's also a positive blood test
the so-called anchor,
the anti-proteinase three anchor test
that can be positive and other vasculitis.
03:08
But here it's very specific for
granulomatosis with polyangiitis.
03:14
And the treatment, as I mentioned
already, is anti-inflammatory,
and that
is with glucocorticoids, cortisone
like drugs,
cyclophosphamide
and even more powerful immunosuppressive.
03:28
If they don't respond,
the patient doesn't respond
to the initial steroid treatment.
03:35
The next syndrome is so-called
Churg-Strauss syndrome,
also known as granulomatosis with polyangiitis.
03:46
except that there is an additional
term added on eosinophilic.
03:50
That is.
03:51
So it's the same term as with the previous
one granulomatosis with polyangiitis.
03:57
But eosinophils are a prominent component
of this entity
so that there is
both peripheral eosinophilia
and they can also be seen
in the vascular inflammation.
04:11
The mean age is about 50 years.
04:14
Often, these patients present
with pulmonary issues, severe asthma
and infiltrates are seen on chest X-ray.
04:22
There can be involvement
of the nerves
so-called mononeuritis multiplex.
04:28
That is, individual nerves
may suddenly develop neuritis
and abnormal function, for example,
abnormal sensation or motor function.
04:39
There is often an allergic rhinitis
or sinusitis,
so that's why this can be confused
with the previous entity
with granulomatosis with polyangiitis
and they can even have
a positive ANCA test.
04:53
But in this case, it's nonspecific.
04:55
And again,
the diagnosis is made by biopsy.
04:59
By the way,
this entity can affect the heart
and can even lead to fatal arrhythmias.
05:04
So this is a very nasty disease.
05:07
And again,
the treatment is with glucocorticoid,
cyclophosphamide or other
immunosuppressive glucocorticoids.
05:14
I don't do it.
05:17
The next syndrome, also still small vessel
syndrome is microscopic polyangiitis.
05:24
This one predominantly affects the kidneys
and the lungs and often
is associated with hemoptysis.
05:32
So him assist with glomerulonephritis and
decreasing kidney function.
05:39
The diagnosis is very often
microscopic polyangiitis.
05:44
There can also be elements
like in Churg-Strauss
with mononeuritis multiplex and,
of course, skin rashes.
05:51
The diagnosis, again by tissue biopsy,
the ANCA test can be positive
but is nonspecific.
05:58
And again,
the treatment is done with glucocorticoids
and cyclophosphamide
and more potent immunosuppressive
if the glucocorticoids
and cyclophosphamide don't work.