VASCUITIDES
Size Examples
Large Giant Cell Arteritis (GCA), Takayasu’s arteritis
Medium Kawasaki disease, Polyarteritis nodosa (PAN)
Small - Medium GPA (Wegener’s), MPA, EGPA (Churg–Strauss),
Small Connective tissue diseases
Variable Behçet’s
• Demographics: elderly, women > men
• Key features: new headache, jaw claudication, scalp tenderness, visual loss, temporal artery tenderness
• Tests:
o ESR >50, CRP raised
o Temporal artery biopsy: granulomatous inflammation
• Urgent treatment:
o Start high-dose steroids immediately to prevent blindness
o Add PPI and bone protection
• Associated with: Polymyalgia rheumatica
• Demographics: young women, esp. Asian
• Key features: systemic symptoms + absent pulses, BP discrepancies, bruits
• Complications: limb claudication, aortic aneurysm
• Investigations:
o Angiography or MRI angiogram: arterial narrowing
• Treatment: steroids ± immunosuppressants
• Key features:
o Mononeuritis multiplex, livedo reticularis
o Mesenteric ischaemia, renal infarcts, HTN
• No pulmonary involvement
• Association: Hepatitis B
• Investigations:
o Angiography: microaneurysms, segmental stenoses
o Hepatitis serology
• Treatment: steroids + cyclophosphamide ± antivirals (if HBV)
• Features (CRASH + burn):
o Conjunctivitis, Rash, Adenopathy (cervical), Strawberry tongue, Hand/foot swelling + peeling
o Fever >5 days
• Complication: coronary artery aneurysms
• Test: Echocardiography
• Treatment: IV immunoglobulin + high-dose aspirin
• Features:
o ENT: sinusitis, nasal crusting, epistaxis
o Resp: cavitating lung nodules, haemoptysis
o Renal: rapidly progressive glomerulonephritis
• Autoantibody: cANCA (anti-PR3)
• Biopsy: necrotising granulomatous vasculitis
• Treatment: steroids + cyclophosphamide or rituximab
• Features:
o Renal-pulmonary syndrome (e.g. glomerulonephritis + alveolar haemorrhage)
o No granulomas, no ENT disease
• Autoantibody: pANCA (anti-MPO)
• Treatment: steroids + immunosuppressants (similar to GPA)
• Features:
o Asthma
o Eosinophilia
o Peripheral neuropathy (mononeuritis multiplex)
o Pulmonary infiltrates
• Autoantibody: pANCA (MPO)
• Biopsy: eosinophilic granulomas
• Treatment: steroids ± cyclophosphamide
• Features:
o Recurrent oral + genital ulcers
o Anterior uveitis
o Erythema nodosum, pathergy test +
o Can cause DVT, cerebral venous sinus thrombosis
• Management: colchicine, steroids, immunosuppressants for organ involvement
• Associated with: Hepatitis C
• Features:
o Palpable purpura, arthralgia, peripheral neuropathy, glomerulonephritis
• Test:
o Serum cryoglobulins
o HCV serology
• Treatment: treat underlying HCV ± immunosuppression if severe
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
