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)
Fatores de risco
- extremes of age
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
Investigações a serem consideradas
- conventional angiography or magnetic resonance angiography (MRA)
- positron emission tomography (PET) scan
Algoritmo de tratamento
suspected giant cell arteritis
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)
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
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.
Diagnósticos diferenciais
- Infective endocarditis
- Hypercoagulability syndromes
- Systemic lupus erythematosus (SLE)
Mais Diagnósticos diferenciaisDiretrizes
- American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
- EULAR recommendations for the management of ANCA-associated vasculitis
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