2. Objectives What is a vasculitis Know the more common and relevant vasulitides. Understand how to investigate and manage these conditions. Case scenario.

3. Definition Multi-system Inflammatory disorder of blood vessels, with systemic and system specific symptoms.

4. Categories Large Vessel PMR Giant cell/temporal Medium Vessel Polyarteritis nodosum Kawasaki’s disease Small vessel Churg Strauss Wegener’s Henoch-schonlein purpura

5. Finals cases Written Any of them Clinical PMR (Giant cell) Wegener’s Churg Strauss

6. Recognising Symptoms All: fatigue, fever, weight loss, anaemia PMR: Pain+stiffness in muscles. Giant cell: temporal tenderness, headache, jaw claudication, Amaurosis fugax.

7. Wegener’s: chronic rhinitis, saddle nose deformity. Cough, haemoptysis, arthritis. Eventually renal impairment. Churg-Strauss: Asthma  heart disease OR skin lesions/nasal polyps.

8. Ix Bedside – Urine dip Bloods – U+Es, FBC, LFTs, - CRP, ESR, ANCA Imaging – depends on symptoms Special tests - biopsy

9. Rx Conservative – Advice Medical – Steroids, immunosuppressants (azathioprine, cyclophosphamide)

10. Case 45 year old man comes to see you with a stuffy nose for the last 5 months. He is troubled by recurrent sinusitis and runny nose. He also feels his nose has changed shape, as if it has “caved in”. He has felt generally unwell with aches and tiredness for the last 3 months. The reason he has come today is that he coughed up blood yesterday and is worried it means he has cancer. On examination his temp is 37.3. He has mild conjunctival pallor and a deformity of his nose. Systemic examination is otherwise unremarkable. You send off some routine bloods and his urea come back at 17 and his creatinine at 350.

12. Questions What are your main differentials for this man? How will you investigate him? How will you manage him? What is the classification for vasculitis? Give examples of each group What are the ANCA positive vasculitides?

13. Summary State the obvious Large medium and small vessel Multi-system Inflammatory disorder of blood vessels, with systemic and system specific symptoms