Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

650 Granulomatous Vasculitis

follow-up

During Treatment

■Regularly assess disease activity by history & physical exam, includ-

ing bilateral blood pressures & heart exam

➣GCA

After 1 month, taper corticosteroid dose by about 5 mg every 2

weeks to 10–15 mg/day, & more slowly thereafter. Most relapses

occur in the first 18 months of treatment. Average duration of

therapy is about 2–3 years.

➣TA

Therapy may be protracted; one-fourth of pts will require years

of immunosuppression

Subclavian involvement is common (90%), & blood pressure

readings may not reflect aortic root pressure. Angiography &

echocardiography may help

Follow-up vascular imaging required

Surgical intervention for critical stenosis or aneurysms

➣WG, CS

Monitor urinalysis, chest radiograph, clinical status

Long-term immunosuppression is usually required

c-ANCA roughly correlates w/ disease activity

complications & prognosis

■Side effects of high-dose steroids: glaucoma, osteoporosis, infection,

hyperglycemia, hyperlipidemia

■GCA

➣Thoracic aortic aneurysms 17 times, abdominal aneurysms 2.5

times more likely than in age-matched controls

➣Vision loss (6–10%)

➣Stroke

➣Pts w/ GCA have a normal life expectancy

■TA

➣Aortic root involvement w/ valvular insufficiency & congestive

heart failure in 20%

➣Stroke

➣Progressive arterial & aorta lesions may require surgery

➣5-year survival 83%; 10-year survival 58% in pts w/ severe disease

■WS, CS

➣Renal failure, stroke, mononeuritis, vision loss; tracheal stenosis,

nasal deformity, infection

➣5-year survival >80%