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VASCULITIS: DIAGNOSIS AND TREATMENT OF INFLAMMATORY BLOOD VESSEL DISEASE

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jcm MD
jcm MD
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VASCULITIS George R. Mount, CPT USA MC Rheumatology Fellow Walter Reed AMC
Goals ,[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object]
Vasculitis: Primary or Secondary? ,[object Object],[object Object]
Classification of Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Vasculitis www.rheumtext.com – Hochberg et al (eds)
When to Suspect a Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to Suspect a Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
When to Suspect a Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
General Approach to Diagnosis ,[object Object],[object Object],[object Object],[object Object]
Demographic Associations
Clues to Diagnosis
Clues to Diagnosis
Clues to Diagnosis
Clues to Diagnosis
Clues to Diagnosis
Approach to Diagnosis: Labs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Diagnosis: ANCAs 101 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Diagnosis: Biopsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Diagnosis: Angiogram ,[object Object],[object Object],[object Object],[object Object]
Approach to Diagnosis: Angiogram
Prognosis ,[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Henoch-Schonlein Purpura ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Henoch-Schonlein Purpura ,[object Object],[object Object],[object Object]
Henoch-Schonlein Purpura ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Henoch-Schonlein Purpura ,[object Object],[object Object],[object Object],[object Object]
Henoch-Schonlein Purpura ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object]
Case
Case She is treated with empiric antibiotics over 3 days with no improvement in symptoms. What is the most likely diagnosis: A. Eosinophilic bronchitis B. Idiopathic hypereosinophilic syndromes C. Churg-Strauss syndrome D. Wegener’s granulomatosis E. Polyarteritis nodosa
Case She is treated with empiric antibiotics over 3 days with no improvement in symptoms. What is the most likely diagnosis: A. Eosinophilic bronchitis B. Idiopathic hypereosinophilic syndromes C. Churg-Strauss syndrome D. Wegener’s granulomatosis E. Polyarteritis nodosa
Churg-Strauss Vasculitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Churg-Strauss: Criteria- 4/6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Churg-Strauss Vasculitis ,[object Object],[object Object],[object Object],[object Object]
Churg-Strauss Vasculitis ,[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wegener’s Granulomatosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wegener’s Granulomatosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wegener’s Granulomatosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Wegener’s Granulomatosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Wegener’s Granulomatosis ,[object Object],Intervention Survival None 50% at 5 months Glucocorticoids 50% at 1 year GCS + Cytoxan 80% at 8 years
Distinguishing CSV & WG CSV WG Asthma +++ uncommon Eosinophils +++ occ /modest Atopy +++ uncommon Upp airway destruction uncommon + Pulmonary nodules occasional ++ Renal failure + ++
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polyarteritis Nodosa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polyarteritis Nodosa ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Polyarteritis Nodosa
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Polyarteritis Nodosa
PAN-Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
PAN- Prognosis &Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Takayasu’s Arteritis ,[object Object],[object Object],[object Object],[object Object]
Takayasu’s Arteritis ,[object Object],[object Object],[object Object],[object Object]
Takayasu’s Arteritis ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Takayasu’s Arteritis
[object Object],[object Object],[object Object],Takayasu’s Arteritis
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Giant Cell Arteritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Giant Cell Arteritis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Giant Cell Arteritis
Giant Cell Arteritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Giant Cell Arteritis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Giant Cell Arteritis
[object Object],[object Object],[object Object],Giant Cell Arteritis
Common Vaculitis Presentations (aka Board Buzz Words…) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Common Vaculitis Presentations (aka Board Buzz Words…) ,[object Object],[object Object],[object Object]
Questions?

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VASCULITIS: DIAGNOSIS AND TREATMENT OF INFLAMMATORY BLOOD VESSEL DISEASE

  • 1. VASCULITIS George R. Mount, CPT USA MC Rheumatology Fellow Walter Reed AMC
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  • 7. Classification of Vasculitis www.rheumtext.com – Hochberg et al (eds)
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  • 37. Case She is treated with empiric antibiotics over 3 days with no improvement in symptoms. What is the most likely diagnosis: A. Eosinophilic bronchitis B. Idiopathic hypereosinophilic syndromes C. Churg-Strauss syndrome D. Wegener’s granulomatosis E. Polyarteritis nodosa
  • 38. Case She is treated with empiric antibiotics over 3 days with no improvement in symptoms. What is the most likely diagnosis: A. Eosinophilic bronchitis B. Idiopathic hypereosinophilic syndromes C. Churg-Strauss syndrome D. Wegener’s granulomatosis E. Polyarteritis nodosa
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  • 50. Distinguishing CSV & WG CSV WG Asthma +++ uncommon Eosinophils +++ occ /modest Atopy +++ uncommon Upp airway destruction uncommon + Pulmonary nodules occasional ++ Renal failure + ++
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