So I just listened to the excellent Episode #61: Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement [Link is to the podcast and show notes] OCTOBER 9, 2017 By MATTHEW WATTO, MD [Link is to the About Page For Dr. Watto and his cohosts].
This episode features rheumatologist, Dr. Rebecca Sharrim who gives us an outstanding review of vasculitis in general as well as of Giant Cell Arteritis.
The show notes of this episode #61 are perfect so just go there to review the notes.
Since the episode was published there have been new recommendations for imaging of Large Vessel Vasculitis from EULAR – Links to the article are in Resource 2 below. I have included the EULAR imaging recommendations table in the body of this post after the images section.
I’ve embedded the podcast here for my convenience and I’ve followed it with the episode’s wonderful time stamp so I can review whatever part I want.
03:07 Picks of the week
09:13 Getting to know our guest
15:00 Clinical case of vasculitis
15:59 Defining and classifying vasculitis
20:55 Workup for suspected vasculitis
23:17 How to explain GCA to a patient
25:08 Typical symptoms of vasculitis
28:00 Chewing gum test
29:34 Interpreting ESR
32:54 Basic exam and lab workup for vasculitis
35:23 Headache and suspicion for GCA/temporal arteritis
38:10 Is a temporal artery biopsy still mandatory?
39:20 Polymyalgia rheumatica
40:59 Steps to take when GCA/temporal arteritis suspected in clinic
43:55 PCP prophylaxis with high dose steroids
46:30 DMARDs and steroid sparing agents
48:12 Imaging studies to aid in diagnosis of GCA
50:50 Complications of long term steroid therapy
52:31 Take home points
Here is the figure from the show notes:
Resource (1) below was useful for me in clarifying my understanding of vasculitis classification.
Resource (2) below, EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice, has excellent recommendations. I have included the Summary Table from the article:
Resource (2), on p 640, also has a useful summary of on the technical aspects of the imaging of large vessel vasculitis:
Box 1 Suggestions for technical and operational parameters on imaging modalities in large vessel vasculitis
Dr. Rebecca Sharim, rheumatologist and guest expert on this podcast, states that one of the keys to a successful rheumatologic diagnosis is a comprehensive rheumatologic review of symptoms. And I in Resource (3) below there is a link to that resource.
(1) 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Arthritis Rheum. 2013 Jan;65(1):1-11. doi: 10.1002/art.37715
(2) EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Rheum Dis. 2018 May;77(5):636-643. doi: 10.1136/annrheumdis-2017-212649. Epub 2018 Jan 22.
(3) New Patient Rheumatology History Form (includes a detailed ROS) [Link is to the PDF] From the American College of Rheumatology – Accessed 11-9-2018
(4) Vasculitis: Case Presentations, a Critical Images slideshow, for more information on clinical, histologic, and radiographic imaging findings in various forms of vasculitis from emedicine.medscape.com.
(5) EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Rheum Dis. 2016 Sep;75(9):1583-94. doi: 10.1136/annrheumdis-2016-209133. Epub 2016 Jun 23.
(6) Damage in the anca-associated vasculitides: long-term data from the European vasculitis study group (EUVAS) therapeutic trials [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Rheum Dis. 2015 Jan;74(1):177-84. doi: 10.1136/annrheumdis-2013-203927. Epub 2013 Nov 15.