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Systemic vasculitis

Last reviewed: 13 Jul 2025
Last updated: 29 Nov 2023

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • constitutional symptoms (e.g., malaise, fever, arthralgia, myalgia)
  • headache and scalp tenderness (giant cell arteritis)
  • visual changes (large-vessel)
  • upper extremity or jaw claudication (large-vessel)
  • asymmetric brachial pulses (large-vessel)
  • bruits (large-vessel)
  • abdominal pain (medium-vessel)
  • foot drop, wrist drop (medium-vessel)
  • cutaneous ulcers (medium-vessel)
  • hematuria (small-vessel)
  • palpable purpura (small-vessel)
  • otorrhea, ear pain, or muffled sensation in the ears (small-vessel)
  • nasal symptoms (small-vessel)
  • sinus pain (small-vessel)
  • wheeze (small-vessel)
  • hemoptysis (small-vessel)
Detalhes completos

Fatores de risco

  • extremes of age
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • antineutrophil cytoplasmic autoantibodies (ANCA)
  • assessment for glomerulonephritis
  • biopsy of affected tissue
Detalhes completos

Investigações a serem consideradas

  • conventional angiography or magnetic resonance angiography (MRA)
  • positron emission tomography (PET) scan
Detalhes completos

Algoritmo de tratamento

Inicial

suspected giant cell arteritis

AGUDA

life-threatening or organ-threatening granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)

non-life-threatening, non-organ-threatening granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)

CONTÍNUA

resistant to treatment at any stage of therapy

Colaboradores

Autores

Brendan Antiochos, MD

Assistant Professor of Medicine

Director, Vasculitis Center

Division of Rheumatology

Johns Hopkins

Baltimore

MD

Declarações

BA has received compensation from Paradigm Medical Communications for CME activities regarding EGPA and Giant Cell Arteritis.

Agradecimentos

Dr Brendan Antiochos would like to gratefully acknowledge Dr Phillip Seo, the previous contributor for this topic.

Declarações

PS is an author of some references cited in this topic.

Revisores

Jason M. Springer, MD, MS

Associate Professor

Vanderbilt University Medical Center

Nashville

TN

Declarações

JMS has served as a consultant and on an advisory board for ChemoCentryx, the manufacturer of avacopan.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Hellmich B, Sanchez-Alamo B, Schirmer JH, et al. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis. 2023 Mar 16;2022-223764.Texto completo  Resumo

Hellmich B, Agueda A, Monti S, et al. 2018 update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020 Jan;79(1):19-30.Texto completo  Resumo

Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol. 2021 Aug;73(8):1366-83.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Systemic vasculitis images
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  • Diretrizes

    • American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
    • EULAR recommendations for the management of ANCA-associated vasculitis
    Mais Diretrizes
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