
FAQ: 3
Classify vasculitis. Outline management of HSP including its complications.
(3 + 3 + 4)
Classification of Vasculitis: 3 marks
I. PREDOMINANTLY LARGE VESSEL VASCULITIS
• Takayasu arteritis
II. PREDOMINANTLY MEDIUM VESSEL VASCULITIS
• Childhood polyarteritisnodosa
• Cutaneous polyarteritisnodosa
• Kawasaki disease
III. PREDOMINANTLY SMALL VESSEL VASCULITIS
A Granulomatous:
• Wegener granulomatosis
• Churg-Strauss syndrome
B Nongranulomatous:
• Microscopic polyangiitis
• Henoch-Schonlein purpura
• Isolated cutaneous leukocytoclastic vasculitis
• Hypocomplementemic urticarial vasculitis
IV. OTHER VASCULITIDES
• Behcet disease
• Vasculitis secondary to infection (including hepatitis B–associated polyarteritisnodosa), malignancies, and drugs, including hypersensitivity vasculitis
• Vasculitis associated with connective tissue disease
• Isolated vasculitis of the central nervous system
• Cogan syndrome
• Unclasssified
Management of HSP: ½ marks x 6 = 3 marks
1. Mainly supportive
2. Analgesia may be achieved by NSAIDs
3. Steroids may be used if there is significant gastrointestinal involvement or renal involvement.
4. Prednisolone (1 mg/kg/day for 1 to 2 wk, followed by taper) reduces abdominal and joint pain but does not alter overall prognosis nor prevent renal disease.
5. For severe disease Intravenous immune globulin (IVIG) and Plasma pheresis has been tried.
6. chronic HSP renal disease is managed with immunosuppressants like –
Azathioprine
Cyclophosphamide
Mycophenolate Mofetil.
Complications of HSP: 1 marks x 4 = 4 marks
- Gastrointestinal - intestinal perforation – immediate complication.
- Renal – HSP nephritis - Major long-term complication
Occurs in 1-2% of children with HSP.
- Cardiovascular – Hypertension
- Children with HSP undergo serial monitoring of blood pressure and urinalyses for 6 months after diagnosis, especially those who presented with hypertension or urinary abnormalities.
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