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Large Vessel Vasculitis for NP

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Large Vessel Vasculitis for the Nurse Practitioner Licensing Exam
Large Vessel Vasculitis
Large vessel vasculitis involves inflammation of the aorta and its major branches, with two primary types: Giant Cell Arteritis (GCA) and Takayasu Arteritis (TA). Both conditions can lead to severe ischemic complications if untreated.
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Giant Cell Arteritis (GCA)
  • Definition:
    • Also known as temporal arteritis, GCA affects the aorta and cranial arteries, often involving the temporal arteries.
    • Closely associated with polymyalgia rheumatica (PMR).
Large vessel vasculitis vessels
  • Epidemiology:
    • Typically affects adults >50 years, with higher prevalence in women and those of Northern European ancestry.
  • Clinical Presentation:
    • Symptoms: Severe headache, scalp tenderness, jaw claudication (pain with chewing), and visual disturbances (transient or permanent vision loss).
    • PMR Association: Often coexists with PMR, causing pain and stiffness in the shoulders and hips.
  • Diagnosis:
    • ESR and CRP: Elevated inflammatory markers.
    • Temporal Artery Biopsy: Gold standard, showing mononuclear cell inflammation and giant cells.
    • Imaging: Ultrasound of the temporal artery may show a “halo sign.”
  • Management:
    • Corticosteroids: High-dose prednisone is used to prevent vision loss.
    • Tocilizumab: An IL-6 inhibitor, used in refractory or relapsing cases.
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Takayasu Arteritis (TA)
  • Definition:
    • A granulomatous vasculitis affecting the aorta and its branches, often resulting in narrowed or occluded arteries.
    • Known as “pulseless disease” due to reduced pulses in affected areas.
  • Epidemiology:
    • Common in young women under 40, especially in Asian and Latin American populations.
  • Clinical Presentation:
    • Symptoms: Fatigue, limb claudication (especially arms), diminished pulses, blood pressure discrepancies, and hypertension secondary to renal artery stenosis.
  • Diagnosis:
    • ESR and CRP: Elevated markers of inflammation.
    • Imaging: MRI or CT angiography to visualize stenosis or occlusion in large vessels.
  • Management:
    • Corticosteroids: Primary treatment, often followed by tapering.
    • Immunosuppressive Agents: Methotrexate or azathioprine for steroid-sparing effects.
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Key Points
  • Giant Cell Arteritis (GCA):
    • Typically in adults >50 with symptoms including headache, jaw pain, visual loss, and PMR association.
    • Diagnosed by biopsy and managed with high-dose steroids; tocilizumab for refractory cases.
  • Takayasu Arteritis (TA):
    • Affects young women with limb claudication, reduced pulses, and blood pressure differences.
    • Diagnosed by imaging; treated with corticosteroids and immunosuppressants.
  • Complications:
    • GCA: Risk of vision loss and aortic aneurysm.
    • TA: Hypertension, limb ischemia, aneurysm formation.

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