Inflammation of vessel walls; classified by vessel size — large (GCA, Takayasu), medium (PAN, Kawasaki), small (ANCA-associated).
History taking
- • Constitutional symptoms + organ-specific (renal, pulm, skin, neuro)
- • Palpable purpura, mononeuritis multiplex
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Pulmonary haemorrhage, RPGN, stroke, visual loss (GCA)
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, CRP, ESR
- • ANCA (cANCA-PR3, pANCA-MPO), ANA, complement
- • Urinalysis + ACR
- • CXR, CT chest, biopsy as indicated
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Urgent rheumatology / nephrology referral
- • High-dose steroids ± cyclophosphamide / rituximab
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • New headache + jaw claudication + ESR >50 in >50 y → start steroids before TA biopsy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
