3. WHAT IS VASCULITIS?
Vasculitis is a clinicopathologic process
characterized by inflammation and damage to
blood vessels,leading to compromise of the
vascular lumen resulting in ischemia of the
tissues supplied by the involved vessels.
36. SPECIFIC THERAPY-IMMUNOMODULATORS
Cyclophosphomide
Indication:
- ANCA + vasculitis- multisystem inv. &
life threatening condition
- steroid non responsive CSS,PAN
Dosage:
- 2mg/kg/d- Rx of choice
- IV cyclophosp. Intermittent bolus
- 15mg/kg thrice infusion every 2 wks, then
every 3 wks
37. S/e-
- BM suppression
- cystitis
- bladder cancer
- infertility, GI intolerance
- pulmonary fibrosis
- myelodysplasia
38. Methotroxate
Indication :
- limited WG- non- life threatening
- cyclophosphomide toxicity
- maintaining remission
Dosage
- start -0.3mg/kg/week ,inc . by 2.5mg/wk
- max.dose- 20-25mg/wk
- maintain remission level
- 2 yr post remission ,taper down by
2.5 mg /mnt and discontinue
41. ROLE OF STEROIDS
Indication for first line therapy
-severe ulcerative,necrotic cutaneous lesion
- GI bleeding
- a./c glomerulonephritis
- peripheral neuropathy with impending
palsy
- primary Rx in CSS,GCA,TA
Dosage
-1mg/kg/d x 1 mnth, then alternate days
- taper down & discontinue in 6-9 mnths
42. ROLE OF IVIG
Indications:
Kawasaki disease-
- Rx of choice
- 2 g/kg single dose infusion over
10 hr with high dose aspirin
- prevents aneurysmal formation
Henoch schonlein purpura
- cutaneous
- renal
- git involvement
43. ROLE OF ASPIRIN
Kawasaki disease
- high dose 10mg/kg/d X 14 d,then
- 3-5mg/kg/d for several weeks
- reduce coronary abnormalities
Giant cell arteritis
- reduce cerebral ischemic
complication
44. ROLE OF ANTIVIRAL THERAPY
Hep .C related cryoglobulinemia
- IFN –alpha preffered drug
- 3 million IU thrice weekly X 12-18 Months
- 60-80% improvement renal,cutaneous,joint
- relapse 90%- ribavarin can be added
Hep .B related PAN
-IFN a + vidarabine + lamivudine in
combination with plasma exchange
45. ROLE OF SURGERY
Takayasu arteritis
- surgical/angioplasty for stenosis
- reduce risk of stroke
- correct HTN due to renal artery
stenosis
- improves blood flow to viscera & limbs
50. Q2 A
45 yr old male presented to opd c/o dyspnoea
athralgia for 2 week.
The patient has h/o asthma for 5 yrs on Rx.
o/e-
P- 82/mt BP- 122/82 mmHg Rt.arm
pallor+,no icterus,LN,jvp
nasal polyposis +
Urinalysis- rbc casts+++,protein++