Systemic Vasculitis

History

• e/o blood vessel injury involving the arterial or venous divisions of the circulation that may be inflammatory in nature, associated with evidence of vessel wall disruption, luminal narrowing or occlusion and subsequent tissue ischemia or necrosis?
• Petechiae/ Purpura/ Ecchymoses
• Nailfold infarcts/ Splinter hemorrhages/ Digital infarcts or ulcer
• Nodules/ Ulcers
• TIA/ CVA/ Amaurosis fugax
• Cranial neuropathy/ Motor neuropathy/ Sensory neuropathy
• Pulmonary infiltrates
• MI/ Abdominal visceral infarct
• Nephritis/ Myositis/ Inflammatory arthritis
• Other ischemic events
• h/o of an underlying disorder that could predispose to vasculitis?
  • Hepatitis B – polyarteritis nodosa
  • Hepatitis C – mixed cryoglobulinemia
  • Chronic rhinosinusitis – Wegener’s granulomatosis
  • Chronic asthma/allergies – Churg-Strauss
  • Recent viral illness – Henoch-Schoenlein purpura
  • Oral and genital ulcers – Behcet’s syndrome
  • Other inflammatory (UC/CD/IBD)
  • Other rheumatologic disorder (RA)
• Any nonspecific symptoms?
  • Weight loss, fevers, arthralgias, myalgia, fatigue/
• Previously evaluated by a rheumatologist? Any other diagnoses? Results?
• Previous laboratory evidence of inflammation and immune systemic activation including elevated acute phase reactants, complement consumption, positive autoantibodies?
• Previous radiographic studies? Cranial MRI? MRA? Angiography? Other?
• Previous biopsies of the skin, lung, peripheral nerves, bowel, or other tissues?
• Previous treatment with NSAIDS? Corticosteroids? Immune suppression drugs?  Results?

Exam

• Completely examine the spine and all peripheral joints noting range of motion, discomfort, evidence of synovitis.  Include the TMJ!
• Perform vascular examination including palpation of temporal artery pulses (beginning just above the TMJ), and carotid and radial artery pulses at minimum.  Auscultate for carotid, subclavian, or brachial artery bruits and cardiac murmurs.
• Note evidence of petechaie, purpura, nailfold infarcts, ulcers, nodules, infarcts, mononeuritis, etc.
• Lymph node exam, lungs, nasal mucosa, oral mucosa, abdomen, neuromuscular
• Note evidence of other systemic diseases that might mimic PMR or GCA especially infections, cancers an other collagen vascular disorders