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Anish Pithadia
Takayasu Arteritis
Younger age asian females Fibrotic vessels- longer term fibrosis leads to shrinkage of vessels. Blood supply to upper extremity is Macrophages, lymphocyte, eosinophils come to the vasa visorum Systemic - Cytokines are produced (malaise, fever) Local features- elastic tissue if destroyed and become fibrotic. Loss of elastic properties. When L v produced systole there is stretch and relaxation. When there is fibrosis and stenosis the pulse in not propagated to the upper extremities. NO PULSE but there is blood flow Ischemia of the upper limbs tingling sensation of upperr limbs can seen as well. Blood flow to CNS is reduced as well dizziness, syncope, neurological dysfunction Sometimes there is aortic dilations- As the aortas doesnt recoil there may be regurgitation of the aortic valve. Coronary Osteal Stenosis may be seen as well intimal wrinkling Rx: corticosteroids
Must biopsy 2-3 cm of the temporal artery Granuloma formation with multitude of cells Seen only in 70% of pts Others have them scattered inflammatory cells Most common systemic vasculitis in adult
Artery may be nodular Ophthalmic artery may be involved and blindness can occur Rx: corticosteroids Lab- very high ESR, blindness(can become permanent), claudication (pains
that result in muscle when the muscle is working, but the vasculature to the area does not relax to supply the area. Vasa nervosum- some segment of the nerve may become infarcted
ASSOCIATED WITH POLYMYALGIA RHEUMATICA Pains of proximal girdle hips shoulders and periarticular inflammation Pts cant comb hair, may find it difficult to even stand
Oral erythema
The visceral artery has transmural inflammation Usually theres always some fibrinoid necrosis
CLINICAL
Systemic- fever, malaise, anorexia, weight loss- Increase in ESR found by
C reactive protein Local
Spillover to the neighboring arteries, veins and nerves Strongly associated with men who smoke
Inject tobacco subdermally and you get hypersensitivity reaction Age of 40 years, India, japan and Israeli descent
The inflammation of the endothelial lining leads to thrombi formation within the
vessel lumen. Also giant cells and in the center microabscesses may be present inside them
Microscopic Polyangitis
Small Vessel p-ANCA positive
Wegners Disease
Necrotizing medium and small-sized vessel vasculitis
Necrotizing vasculitis in lungs (infarction and hemoptysis) C-ANCA antibodies (>90% of cases) correlate erratically with
therapy
Bad Biopsy
Searching for PAN
Not deep enough and only contains superficial dermis and epidermis. WHY? PAN affects medium sized arteries tat are located deep within the dermis
Good Biopsy
Urine Analysis
Almost always done when
suspecting vasculitis in patients
Temporal Biopsy
Used to diagnose Giant
Cell Temporal Arteritis
Lung Biopsy
Used for diagnosing vasculitis that may have to do with
the lungs Ie (Wegners)
Abdominal Angiogram
Helpful in the diagnosis of
Polyarteritis Nodosa(PAN) Diagnosis is based on
out-pouchings that are seen when the dye is injected Diagnostic of PAN
Similar to a heart
catheterization
ANCA
Group do anutoantibodies
C-ANCA