Last reviewed: November 2017
Last updated: June  2016

Summary

Definition

History and exam

Key diagnostic factors

  • age 40 to 60 years
  • blood transfusion at a time before routine screening for hepatitis B virus (HBV)
  • previous or current intravenous drug abuse
  • recent hepatitis B virus (HBV) infection
  • fever
  • weight loss
  • myalgia or arthralgia
  • mononeuritis multiplex
  • paresthesia
  • muscle tenderness
  • abdominal pain
  • skin manifestations
  • diastolic blood pressure >90 mmHg
  • testicular pain

Other diagnostic factors

  • male sex
  • hairy cell leukemia
  • seizure
  • upper motor neuron weakness
  • GI bleeding
  • peritonitis
  • monocular blindness
  • chest pain
  • congestive cardiac failure
  • tender breast lumps

Risk factors

  • hepatitis B virus (HBV) infection
  • age 40 to 60 years
  • hairy cell leukemia
  • blood transfusion at a time before routine screening for hepatitis B virus (HBV)
  • hepatitis C virus (HCV) infection
  • male sex

Diagnostic investigations

1st investigations to order

  • CRP
  • ESR
  • CBC
  • complement
  • serum creatinine
  • midstream urine analysis
  • liver function tests
  • hepatitis B virus (HBV) serology
  • hepatitis C virus (HCV) serology
  • cryoglobulins
  • blood culture
  • creatine kinase
  • antineutrophil cytoplasmic antibodies (ANCA)
  • antinuclear antibody (ANA)
  • anti-double-stranded DNA antibodies (anti-dsDNA)
  • rheumatoid factor
  • antibodies to cyclic citrullinated peptides (anti-CCP antibodies)
  • lupus anticoagulant
  • IgG antiphospholipid antibodies
  • B2 glycoprotein
  • fibrinogen
  • conventional digital subtraction angiography
  • echocardiography
Full details

Investigations to consider

  • MR angiography (MRA)
  • CT angiography
  • biopsy of affected tissue
  • HIV serology
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Rheumatologist

Auckland and Counties Manukau District Health Boards

Auckland

New Zealand

Disclosures

RS declares that he has no competing interests.

Rheumatology Registrar

Nuffield Orthopaedic Centre

Oxford

UK

Disclosures

JR has attended symposia sponsored by Roche Ltd.

Professor of Medicine

Rheumatology Department

Hopital Cochin

Paris

France

Disclosures

LG is an author of a number of references cited in this monograph.

Professor of Rheumatology

NIHR Musculoskeletal Biomedical Research Unit

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science

University of Oxford

Oxford

UK

Disclosures

RL has attended symposia sponsored by GlaxoSmithKline, the manufacturer of Epivir (lamivudine), and has received sponsorship from Roche, Abbot Ltd, Schering Plough (the manufacturer of Remicade [infliximab]), and Wyeth (the manufacturer of Enbrel [etanercept]) to attend conferences. RL has received sponsorship from Sanofi Aventis (the manufacturer of Arava [leflunomide]) to support the costs of a meeting, and is on the Roche advisory board looking at treatment of vasculitis with B cell therapy. RL is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Professor and Vice Chair

Department of Medicine

University of Wisconsin Hospital

Madison

WI

Disclosures

AB declares that he has no competing interests.

Consultant Rheumatologist

Ipswich Hospital

Ipswich

UK

Disclosures

RW has received fees for consulting from Roche Pharmaceuticals, manufacturer of rituximab. His department has received financial support from Wyeth Pharmaceuticals, manufacturer of etanercept, and from Schering-Plough, manufacturer of infliximab. RW is an author of a number of references cited in this monograph.

Professor of Medicine

Department of Medicine

UMDNJ-Robert Wood Johnson Medical School

New Brunswick

NJ

Disclosures

ECE declares that she has no competing interests.

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