Small Vessel Vasculitis

Size: px
Start display at page:

Download "Small Vessel Vasculitis"

Transcription

1 Banff- Rocky Mountain Barry Kassen, MD, FRCPC,FACP Head, Division of Internal Medicine UBC/VGH/SPH Acting Head, Division of Community Internal Medicine November, 2009

2 Objectives 1. To understand small vessel vasculitis 2. To understand an approach to therapy of small vessel vasculitis

3 Classification of Vasculitis 1. Large vessel vasculitis 2. Medium vessel vasculitis 3. Small vessel vasculitis Plus: Antineutrophil Cytoplasmic Antibodies (ANCA)

4 Classification (continued) Large Vessel Vasculitis Takayasu s Giant Cell Arteritis 2. Medium Sized Vessel Vasculitis Polyarteritis Nodosa (PAN) Microscopic Polyarteritis (MPA) Kawasaki s Disease Primary Central Nervous System Vasculitis 3. Small Vessel Vasculitis Churg-Strauss Arteritis (CSA) Wegeners Granulomatosis (WG) Microscopic Polyarteritis (MPA) Henoch- Schonlein Purpura Essential Cryoglobulinemic Vasculitis Hypersensitivity Vasculitis Vasculitis Secondary to Connective Tissue Disorders Vasculitis Secondary to Viral Infections

5 Mimics and Secondary Causes of Vasculitis Mimics of vasculitis Secondary causes of vasculitis Atheroembolic disease Infections Tuberculosis Atheromatous vascular disease Hepatitis B Anti-phospholipid syndrome Hepatitis C Multiple myeloma HIV Infective endocarditis Parvovirus Other chronic infections Cystic fibrosis Para-neoplastic syndromes Malignancy Lymphoma Autoinflammatory syndromes Solid organ malignancy Hypersensitivity reactions Connective tissue disorders Rheumatoid arthritis Cocaine and amphetamine abuse Systemic lupus erythematosus Scleroderma Sjogren s syndrome Drugs Penicillamine Propylthiouracil Hydralazine Minocycline Cocaine Environmental exposure Dusts Silica

6

7 A diagnostic pathway for vasculitis Components of a vasculitis diagnosis 1. Compatible clinical phenotype 2. Supported by specific serology (e.g. ANCA) or radiology (e.g. angiography) 3. Confirmation by tissue biopsy 4. Exclusion of mimics and secondary causes 5. Observation over time to improve certainty of diagnosis (D. Jayne / Best Practice & Research Clinical Rheumatology 23 (2009) )

8 Clinical Spectrum of Antineutrophil Cytoplasmic Antibodies (ANCA) discovered Two types of ANCA assays Indirect Immunofluorescence assay (IF) Enzyme Linked Immunosorbent assay (ELISA) Target antigens Proteinase 3 (PR3) Myeloperoxidase (MPO)

9 Immunofluorescence Patterns in Vasculitis Incubate patients serum with ethanol-fixed neutrophils (alcohol fixed buffy coat leukocytes) 2 patterns seen visually #1 C- ANCA There is diffuse straining throughout the cytoplasm. (antigen is proteinase 3) #2 P-ANCA There is staining around the nucleus (antigen is myeloperoxidase) Caution: ANCA testing has no references for normal range Positive predictive value for vasculitis 25%-50% There are other antigens in the cytoplasm (lactoferrin, elestase, etc.) ANA positive may give false positive. (to P-ANCA)

10 C-ANCA

11 P- ANCA

12 Enzyme-Linked Immonoassays (ELISA) This test is more specific than I.F and so is performed following I.F. Antibodies to: Proteinase 3 (PR3) Myeloperoxidase (MPO) C-ANCA Most cases antibody is to PR3 P-ANCA Most cases antibody to Myeloperoxidase (MPO) ELISA has higher specificity and higher positive predicative values for vasculitis.

13 Disease Associations with ANCA Wegener s Granulomatosis, microscopic polyarteritis, Churg-Strauss, renal-limited vasculitis, drug induced vasculitis syndromes. Classic drug association is propylthiouracil or methimazole. Nonvasculitis Rheumatic Disorders RA, SLE, Sjogren s Syndrome, JRA, Scleroderma Autoimmune Gastrointesinal Disorders Ulcerative Colitis Crohn s disease Cystic Fribrosis Others: Subacute bacterial endocarditis Infectious mononucleosis graft vs.. host autoimmune hepatitis etc.

14 ANCA Is a positive test a True Positive? IF- positive predictive value for vasculitis- 45% ELISA- positive predictive value 83% IF plus ELISA-88% Does a negative ANCA exclude small vessel vasculitis? 40% of limited Wegener s are ANCA negative 10% of severe Wegener s are ANCA negative 30% of MPA 50% of CSS

15 Does a positive ANCA alleviate the need for confirmation of diagnosis by tissue biopsy? The Predictive value of ANCA testing depends heavily on the clinical situation. Multi-centered European Collaborative study (Kidney International 1998). Comparison of vasculitis patients with controls who had other vasculitis, other glomerulopathies, etc and 740 healthy volunteers. Sensitivity and specificity of ANCA (IF/ELISA) varied for WG, MPA, and pauci-immune vasculitis. Therefore a biopsy is still required in ANCA positive patients to make a diagnosis of Primary Vasculitis.

16 Does a Rise in ANCA Predict a Disease Flare? WGET (Research group, 2005) 180 patients followed by ANCA 3 monthly. No difference in median time to relapse, disease activity or organ involvement. Controversy, though, still exists. Does Persistently Negative ANCA Assure Disease quiescence? If initially positive then helpful for proof of remission.

17 Epidemiology of Small Vessel Vasculitis Is Systemic vasculitis becoming more common? Incidence of ANCA associated vasculitis in Norfolk, England incidence 20.3 case per million incidence 17.1 cases per million Incidence in Northern Germany 1999-incidence 48 cases per million incidence 42 cases per million

18 Pathogenesis of Vasculitis Do leukotriene inhibitors cause Churg-Strauss Syndrome? 1998 Wechsler- 8 cases of glucocorticoid-dependant asthma treated with zafirlukast. Developed Eosinophilia, pulmonary infiltrates and cardiomyopathy Mayo Clinic Review (91 cases) of Churg-Strauss 16 cases received leukotriene inhibitors before onset of disease. 6 patients received leukotriene inhibitors during remission. 4 years interval between onset of asthma and vasculitis in both groups (16/91; 65/91) 4/6 patients in remission received leukotrienes with no flare.

19 What is the significance of ANCA among patients with Churg-Strauss Vasculitis? Patients with this disease may be ANCA (MPO) positive or negative. Retrospective analysis 93 patients ( ) 35 ANCA Positive small vessel vasculitis disease Manifest by: Purpura (25.7% vs. 6.9%) Pulmonary hemorrhage (20.0% vs. 0%) Mononeuritic multiplex (51.4% vs. 24.1%) Renal involvement (51.4% vs. 12.1%) ANCA Negative Patients Parenchymal lung disease Cardiac involvement Are there 2 phenotypes based on ANCA status? ANCA positive with vasculitic manifestation? ANCA negative with eosinophil driven processes leading to cardiopulmonary manifestation?

20 Treatment of Vasculitis Are short courses of cyclophosphamide effective for the treatment of ANCA associated vasculitis (AAV)? CYCAZAREM (Cyclophosphamide or Azathioprine as a Remission for Vasculitis) NEJM Patients WG or MPA Induction therapy: (3 months) Cyclophosphamide 2 mg/kg p.o. Prednisone 1 mg/kg/p/o. Post induction: (3 month-12 months) Cyclophosphamide 1.5 mg/kg p.o. Azathioprine 2 mg/kg (prednisone 10 mg daily) 12 months to 10 months all patients switched to AZA 1.5 mg/kg plus prednisone 7.5 mg daily. Relapse rate the same: Cyclophosphamide- 14% AZA 16%

21 Is there a role for plasma exchange in the treatment of ANCA associated vasculitis? European union vasculitis study group (EUVAS) MEPEX Trial- 2007, 137 patients randomized to Methylprednisone IV or plasma exchange. Results: All patients had serum creatine greater than 500 micromoles Plasma exchange 7 over 2 weeks Methylprednisolone one gram daily x3 Both groups received cyclophasphmade 2.5 mg/kg and prednisone 60 mg daily. 35 died during the trial. 23/35 died in the first 3months. 71/137 had independent renal function.

22 Mepex Trial Results (cont d) Plasma exchange was associated with a significantly higher likelihood of being alive and having independent renal function at 3 months. 69% in plasma exchange gp 49% in methylprednisone gp Plasma exchange was associated with a significant reduction in risk of progression to end stage renal disease at one year. 19% vs. 43% Mortality rate high in both groups 35/137 (infection, pulmonary hemorrhage, CVS)

23 Are TNF inhibitors effective treatment of ANCA associated vasculitis? WGET (Wegener s Granulomatosis etanercept trial) Design to see if etanercept, after induction therapy, would maintain remission ( in patients who were maintained on standard therapy) 180 patients (follow up 27 months) 50% patients who achieved remission 126/180 were able to maintain this. There was no difference in remission rate, flares or adverse events between groups. But, 6 etanercept patients developed malignancies (no control patients)

24 Do early generalized ANCA associated vasculitis patients treated with methotrexate fare as well as those treated with cyclophosphamide? NORAM (Non-renal Alternative with Methotrexate trial), De Grout patients with limited Wegener s received either methotrexate or cyclophosphamide with glucocortoids. 6 month remission rates MTX-89.8% CYC- 93.5% 18 month relapse rates MTX 69.5% CYC 46.5% Higher does of prednisone in MTX group 8.8 vs. 6.2

25 Remission Maintenance in Vasculitis When should remission maintenance be stopped for patients with ANCA associated vasculitis? NIH longitudal study (1992) 33% cured after first course of RX. CYCAZAREM WG is more likely than MPA to flare. Clinical trials in AAV Support use of lose dose prednisone to maintain remission.

26 Are patients with systemic vasculitis at risk of Venous thromboembolism? Venous obstruction (SVC or IVC occlusion) or Budd Chiari syndrome has been reported in Bechet s disease. Superficial phlebitis.. Buerger s disease. Wegener s Granulomatosis..venous thrombosis (Annals of Internal Med- 2005) is seven times greater than the incidence in patients with systemic lupus erythematosis.

27 References Small vessel and Nuclear Vessel Vasculitis- Seo/Johnston, Arthritis and Rheumatism Vol 57, No. 8, Dec 15, 2007, p The Diagnosis of Vasculitis, Jayne, Best Practice and Research Clinical Rheumatology 23 (2009) EULAR Recommendations for the management of primary small and medium vessel vasculitis, Ann Rheum Dis 2009; 68; The Last Classification of Vasculitis- Kallenberg, Clinic Rev Allerg Immunol (2008) 35:5-10 Uptodate- 2009, Rhuematoid Disease Clinics of North America, Vasculitis Azathoprine or Methotrexate Maintenance for ANCA- Associated Vasculitis-Pagnoux, NEJM 2008; 359;

EDITORIAL. Issue Seventeen, October Editorial Team. Issue Seventeen. Info link

EDITORIAL. Issue Seventeen, October Editorial Team. Issue Seventeen. Info link EDITORIAL, October 2004 Welcome to the Spring 2004 Edition of InfoLink. The feature article in this edition has been written by Dr Rodger Laurent, Head of Department, PaLMS Rheumatology Laboratory. The

More information

anti-neutrophil cytoplasmic antibody, myeloperoxidase, microscopic polyangiitis, cyclophosphamide, corticosteroid

anti-neutrophil cytoplasmic antibody, myeloperoxidase, microscopic polyangiitis, cyclophosphamide, corticosteroid Online publication June 24, 2009 ANCA JMAAV 1 2 ANCA JMAAV MPO-ANCA 18 17 50 J Jpn Coll Angiol, 2009, 49: 53 61 anti-neutrophil cytoplasmic antibody, myeloperoxidase, microscopic polyangiitis, cyclophosphamide,

More information

Annual Rheumatology & Therapeutics Review for Organizations & Societies

Annual Rheumatology & Therapeutics Review for Organizations & Societies Annual Rheumatology & Therapeutics Review for Organizations & Societies Update on Granulomatosis with Polyangiitis (Wegener s) Learning Objectives Identify the clinical features of granulomatosis with

More information

Vasculitis. Edward Dwyer, M.D. Division of Rheumatology. Vasculitis

Vasculitis. Edward Dwyer, M.D. Division of Rheumatology. Vasculitis Edward Dwyer, M.D. Division of Rheumatology VASCULITIS is a primary inflammatory disease process of the vasculature Determinants of the Clinical Manifestations of : Target organ involved Size of vessel

More information

ANCA associated vasculitis in China

ANCA associated vasculitis in China ANCA associated vasculitis in China Min Chen Renal Division, Peking University First Hospital, Beijing 100034, P. R. China 1 General introduction of AAV in China Disease spectrum and ANCA type Clinical

More information

ANCA+ VASCULITIDES CYCAZAREM,

ANCA+ VASCULITIDES CYCAZAREM, ANCA+ VASCULITIDES CYCAZAREM, q Comparison of 3 to 6 mo. oral CYC + CS then azathioprine or oral CYC for 12 mo.+ 10 mg/d CS. After 12 mo all the patients were treated with azathioprine q 150 patients followed

More information

Dr Rodney Itaki Lecturer Anatomical Pathology Discipline. University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology

Dr Rodney Itaki Lecturer Anatomical Pathology Discipline. University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology Vasculitis Dr Rodney Itaki Lecturer Anatomical Pathology Discipline University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology Disease Spectrum Hypersensitivity vasculitis/microscopic

More information

Vascularites rénales associées aux ANCA

Vascularites rénales associées aux ANCA Vascularites rénales associées aux ANCA Société Médicale des Hôpitaux de Paris 16 Mars 2012 Philippe Vanhille Néphrologie et Médecine Interne Hôpital de Valenciennes Classification of systemic vasculitis:

More information

SMALL TO MEDIUM VASCULITIS: RENAL ASPECT RATANA CHAWANASUNTORAPOJ UPDATE IN INTERNAL MEDICINE 2018

SMALL TO MEDIUM VASCULITIS: RENAL ASPECT RATANA CHAWANASUNTORAPOJ UPDATE IN INTERNAL MEDICINE 2018 SMALL TO MEDIUM VASCULITIS: RENAL ASPECT RATANA CHAWANASUNTORAPOJ UPDATE IN INTERNAL MEDICINE 2018 OUTLINE Renal involvement in vasculitis Curr Rheumatol Rep 2013 Renal involvement in ANCA vasculitis GN***:

More information

Tell me more about vasculitis. Lisa Willcocks Consultant in Nephrology and Vasculitis, Addenbrooke s Hospital

Tell me more about vasculitis. Lisa Willcocks Consultant in Nephrology and Vasculitis, Addenbrooke s Hospital Tell me more about vasculitis Lisa Willcocks Consultant in Nephrology and Vasculitis, Addenbrooke s Hospital Talk overview Case study ANCA-associated vasculitis What is ANCA vasculitis? What causes ANCA

More information

TREATMENT OF ANCA-ASSOCIATED VASCULITIS

TREATMENT OF ANCA-ASSOCIATED VASCULITIS TREATMENT OF ANCA-ASSOCIATED VASCULITIS Loïc Guillevin Hôpital Cochin, Université Paris Descartes Cours DU, 11 mars 2016 1 Disclosure of interest regarding this presentation Roche has provided, in part,

More information

Mohammad Reza Shakibi M.D Kerman university of medical sciences (KMU) Shafa Hospital, Rheumatology ward

Mohammad Reza Shakibi M.D Kerman university of medical sciences (KMU) Shafa Hospital, Rheumatology ward VASCULITIS SYNDROMES Mohammad Reza Shakibi M.D Kerman university of medical sciences (KMU) Shafa Hospital, Rheumatology ward ILLUSTRATED CASE 1 A 56 years old lady refered me for prolonged fever, arthritis

More information

The systemic vasculitides were traditionally classified. Treatment of ANCA-associated Systemic Vasculitis. H. Michael Belmont, M.D.

The systemic vasculitides were traditionally classified. Treatment of ANCA-associated Systemic Vasculitis. H. Michael Belmont, M.D. 60 Treatment of ANCA-associated Systemic Vasculitis H. Michael Belmont, M.D. Abstract The antineutrophil cytoplasmic antibodies (ANCA)-associated small vessel vasculitides include Wegener s granulomatosis,

More information

SHO Teaching. Dr. Amir Bhanji Consultant Nephrologist, Q.A hospital, Portsmouth

SHO Teaching. Dr. Amir Bhanji Consultant Nephrologist, Q.A hospital, Portsmouth SHO Teaching Vasculitis Renal medicine Dr. Amir Bhanji Consultant Nephrologist, Q.A hospital, Portsmouth OUTLINE What is vasculitis Causes Classification Brief look into ANCA Associated Vasculitis (AAV)

More information

PAEDIATRIC VASCULITIS

PAEDIATRIC VASCULITIS PAEDIATRIC VASCULITIS Lawrence Owino Okong o, Mmed (UoN); Mphil. (UCT). Lecturer, Department of Paediatrics and Child Health, University of Nairobi. Paediatrician/ Rheumatologist. OUTLINE Introduction

More information

Rituximab treatment for ANCA-associated vasculitis in childhood

Rituximab treatment for ANCA-associated vasculitis in childhood Rituximab treatment for ANCA-associated vasculitis in childhood DISCLOSURE I have no relevant financial relationships to disclose Katharine Moore MD Nov 14, 2012 University of Colorado School of Medicine

More information

December 6, 2010 Asthma and Rheumatic Disorders and Vasculitis

December 6, 2010 Asthma and Rheumatic Disorders and Vasculitis December 6, 2010 Asthma and Rheumatic Disorders and Vasculitis Lanny J. Rosenwasser, M.D. Dee Lyons/Missouri Endowed Chair in Immunology Research Professor of Pediatrics Allergy-Immunology Division Childrens

More information

New Evidence reports on presentations given at EULAR Rituximab for the Treatment of Rheumatoid Arthritis and Vasculitis

New Evidence reports on presentations given at EULAR Rituximab for the Treatment of Rheumatoid Arthritis and Vasculitis New Evidence reports on presentations given at EULAR 2011 Rituximab for the Treatment of Rheumatoid Arthritis and Vasculitis Report on EULAR 2011 presentations Anti-TNF failure and response to rituximab

More information

Vasculitis and Vasculitides. OMONDI OYOO Physician/Rheumatologist; Senior Lecturer, Department of Medicine University of Nairobi

Vasculitis and Vasculitides. OMONDI OYOO Physician/Rheumatologist; Senior Lecturer, Department of Medicine University of Nairobi Vasculitis and Vasculitides OMONDI OYOO Physician/Rheumatologist; Senior Lecturer, Department of Medicine University of Nairobi Definition Presence of leucocytes in the vessel wall with reactive damage

More information

Vasculitis local: systemic

Vasculitis local: systemic Vasculitis Inflammation of the vessel wall. Signs and symptoms: 1- local: according to the involved tissue 2- systemic:(fever, myalgia, arthralgias, and malaise) Pathogenesis 1- immune-mediated 2- infectious

More information

Atlas of the Vasculitic Syndromes

Atlas of the Vasculitic Syndromes CHAPTER e40 Atlas of the Vasculitic Syndromes Carol A. Langford Anthony S. Fauci Diagnosis of the vasculitic syndromes is usually based upon characteristic histologic or arteriographic findings in a patient

More information

Diagnostic Tests in Rheumatic Disease: What s Old, What s New & What s Useful? COPYRIGHT

Diagnostic Tests in Rheumatic Disease: What s Old, What s New & What s Useful? COPYRIGHT Diagnostic Tests in Rheumatic Disease: What s Old, What s New & What s Useful? Robert H. Shmerling, M.D. Beth Israel Deaconess Medical Center Boston, MA Diagnostic Tests in Rheumatic Disease: What's Old,

More information

Wegener s Granulomatosis JUN-KI PARK

Wegener s Granulomatosis JUN-KI PARK Wegener s Granulomatosis JUN-KI PARK Definition History Epidemiology Clinical symptoms Pathophysiology Treatment Wegener granulomatosis (WG) is a complex, immunemediated disorder, which along with microscopic

More information

Autoimmune Disease. Autoimmunity. Epidemiology. ACR Criteria for Diagnosis. Signs and Symptoms. Autoreactivity: Reactivity to self antigens:

Autoimmune Disease. Autoimmunity. Epidemiology. ACR Criteria for Diagnosis. Signs and Symptoms. Autoreactivity: Reactivity to self antigens: Autoimmunity Reactivity to self antigens: Autoreactivity: Autoimmune Disease T cells B cells Leading to tissue damage or dysfunction Occurring in the absence of ongoing infection Epidemiology SLE Pathogenesis

More information

Autoimmunity. Autoimmune Disease

Autoimmunity. Autoimmune Disease Autoimmunity Reactivity to self antigens: T cells B cells Autoimmune Disease Autoreactivity: Leading to tissue damage or dysfunction Occurring in the absence of ongoing infection 1 SLE Pathogenesis Immune

More information

EULAR/ERA-EDTA recommendations for the management of ANCAassociated

EULAR/ERA-EDTA recommendations for the management of ANCAassociated EULAR/ERA-EDTA recommendations for the management of ANCAassociated vasculitis Dr. Meharunnisha Syed III year DNB Resident (General Medicine) Narayana Health-MSH Fifteen recommendations were developed,

More information

RATIONALE. K Without therapy, ANCA vasculitis with GN is associated. K There is high-quality evidence for treatment with

RATIONALE. K Without therapy, ANCA vasculitis with GN is associated. K There is high-quality evidence for treatment with http://www.kidney-international.org chapter 13 & 2012 KDIGO Chapter 13: Pauci-immune focal and segmental necrotizing glomerulonephritis Kidney International Supplements (2012) 2, 233 239; doi:10.1038/kisup.2012.26

More information

VASCULITIC SYNDROMES. Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R. OPSC 2018

VASCULITIC SYNDROMES. Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R. OPSC 2018 VASCULITIC SYNDROMES Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R. OPSC 2018 2012 REVISED CHAPEL HILL CONSENSUS CONFERENCE Large vessel Takayasu arteritis Giant cell arteritis Medium Vessel Polyarteritis

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A ANCA vasculitis. See Antineutrophil cytoplasmic antibody associated (ANCA) vasculitis Angiography 54 Antineutrophil cytoplasmic antibody correlation

More information

EUVAS update June 5 th Marinka Twilt

EUVAS update June 5 th Marinka Twilt EUVAS update June 5 th 2012 Marinka Twilt Chapel Hill 2012 Classification Large Vessel Vasculitis (LVV) Medium Vessel Vasculitis (MVV) Small Vessel Vasculitis (SVV) Variable Vessel Vasculitis (VVV) Single

More information

Antineutrophil cytoplasm antibody associated vasculitis: recent developments

Antineutrophil cytoplasm antibody associated vasculitis: recent developments mini review http://www.kidney-international.org & 2013 International Society of Nephrology Antineutrophil cytoplasm antibody associated vasculitis: recent developments Shunsuke Furuta 1 and David R.W.

More information

Small Vessel Vasculitis

Small Vessel Vasculitis Small Vessel Vasculitis Paul A Brogan Professor of Vasculitis and Consultant Paediatric Rheumatologist Department of Rheumatology Institute of Child Health and Great Ormond St Hospital, London UK P.brogan@ucl.ac.uk

More information

ANCA-associated vasculitis. Vladimir Tesar Department of Nephrology, General University Hospital, Prague, Czech Republic

ANCA-associated vasculitis. Vladimir Tesar Department of Nephrology, General University Hospital, Prague, Czech Republic ANCA-associated vasculitis Vladimir Tesar Department of Nephrology, General University Hospital, Prague, Czech Republic Disclosure of Interests Abbvie, Amgen, Baxter, Bayer, Boehringer-Ingelheim, Calliditas,

More information

The European and French networks. Christian Pagnoux, MD, MSc, MPH Mount Sinai Hospital, Toronto, Canada Cochin Hospital, Paris, France

The European and French networks. Christian Pagnoux, MD, MSc, MPH Mount Sinai Hospital, Toronto, Canada Cochin Hospital, Paris, France The European and French networks Christian Pagnoux, MD, MSc, MPH Mount Sinai Hospital, Toronto, Canada Cochin Hospital, Paris, France French Vasculitis Study Group December 1980: L. Guillevin no research,

More information

Management of Acute Vasculitis. CMT teaching 3 rd June 2015 Caroline Wroe

Management of Acute Vasculitis. CMT teaching 3 rd June 2015 Caroline Wroe Management of Acute Vasculitis CMT teaching 3 rd June 2015 Caroline Wroe Vasculitis pub quiz Match the date with the event Dr Peter McBride, Scottish Otolaryngologist describes a disease of rapid destruction

More information

Managing Acute Medical Problems, Birmingham Vasculitis. David Jayne. University of Cambridge

Managing Acute Medical Problems, Birmingham Vasculitis. David Jayne. University of Cambridge Managing Acute Medical Problems, Birmingham 2016 Vasculitis David Jayne University of Cambridge Disclosures Astra Zeneca, Aurinia, BIOGEN, Boehringer, Chemocentryx, Genzyme/Sanofi, GSK, Lilly, Medimmune,

More information

Vasculitis local: systemic

Vasculitis local: systemic Vasculitis Inflammation of the vessel wall. Signs and symptoms: 1- local: according to the involved tissue 2- systemic:(fever, myalgia, arthralgias, and malaise) Pathogenesis 1- immune-mediated inflammation

More information

VASCULITIS. Case Presentation. Case Presentation

VASCULITIS. Case Presentation. Case Presentation VASCULITIS Case Presentation The patient is a 24 year old woman who presented to the emergency room with left-sided weakness. She was confused and complained of a severe headache. She was noted to have

More information

Overview. = inflammation of vessel wall. Symptoms and signs depend on the tissue of which the vessels are affected

Overview. = inflammation of vessel wall. Symptoms and signs depend on the tissue of which the vessels are affected Vasculitis (1+2) Overview = inflammation of vessel wall Symptoms and signs depend on the tissue of which the vessels are affected Often with systemic symptoms fever, myalgia, arthralgia, malaise etc. Most

More information

TREATMENT OF ANCA-ASSOCIATED VASCULITIS AN UPDATE. Loïc Guillevin. Hôpital Cochin, Université Paris Descartes. DU MALADIES SYSTEMIQUES, 7 March 2014

TREATMENT OF ANCA-ASSOCIATED VASCULITIS AN UPDATE. Loïc Guillevin. Hôpital Cochin, Université Paris Descartes. DU MALADIES SYSTEMIQUES, 7 March 2014 TREATMENT OF ANCA-ASSOCIATED VASCULITIS AN UPDATE Loïc Guillevin Hôpital Cochin, Université Paris Descartes DU MALADIES SYSTEMIQUES, 7 March 2014 1 Disclosure of interest regarding this presentation Former

More information

Rheumatologic Lab Tests

Rheumatologic Lab Tests Rheumatologic Lab Tests What the Practitioner Needs to Know Mary Nakamura M.D. 2008 Rheumatologic Lab Tests Are rarely diagnostic of any specific disease If you do not have in mind a rheumatologic disease

More information

Year In Review: VasculitisPers. Disclosures. Learning Objectives. none 4/16/2018. Describe new medications for the treatment of vasculitis

Year In Review: VasculitisPers. Disclosures. Learning Objectives. none 4/16/2018. Describe new medications for the treatment of vasculitis Year In Review: VasculitisPers Cailin Sibley, M.D., M.H.S. Director, Vasculitis Clinic April 27 th, 2018 NTEREST DISCLOSURE Disclosures none Learning Objectives Describe new medications for the treatment

More information

Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis.

Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Bossuyt X, Cohen Tervaert JW, Arimura Y, Blockmans D, Flores-Suárez LF, Guillevin

More information

A. Smržová. III. Interní klinika FN Olomouc nefrologická, revmatologická a endokrinologická

A. Smržová. III. Interní klinika FN Olomouc nefrologická, revmatologická a endokrinologická A. Smržová III. Interní klinika FN Olomouc nefrologická, revmatologická a endokrinologická Systemic vasculitis destructive inflamatory of the walls of blood vessels. Pathologist Inflammatory destruction

More information

Done by: Shatha Khtoum

Done by: Shatha Khtoum Done by: Shatha Khtoum Overview Vasculitis -Vasculitis is a general term for vessel wall inflammation -Symptoms and signs depend on the tissue of which the vessels are affected. (slide 2) -There are usually

More information

T he primary systemic vasculitides (PSV) are clinically

T he primary systemic vasculitides (PSV) are clinically 605 EXTENDED REPORT EULAR recommendations for conducting clinical studies and/ or clinical trials in systemic vasculitis: focus on anti-neutrophil cytoplasm antibody-associated vasculitis Bernhard Hellmich,

More information

Case Presentation VASCULITIS. Case Presentation. Case Presentation. Vasculitis

Case Presentation VASCULITIS. Case Presentation. Case Presentation. Vasculitis Case Presentation VASCULITIS The patient is a 24 year old woman who presented to the emergency room with left-sided weakness. She was confused and complained of a severe headache. She was noted to have

More information

Update and Review on Vasculitis. Ramona Raya, MD ACP Internal Medicine Congress August 7, 2015

Update and Review on Vasculitis. Ramona Raya, MD ACP Internal Medicine Congress August 7, 2015 Update and Review on Vasculitis Ramona Raya, MD ACP Internal Medicine Congress August 7, 2015 Outline Classification and nomenclature updates Small vessel vasculitis Pathophysiology Diagnosis Management/therapeutic

More information

Vasculitides in Surgical Neuropathology Practice

Vasculitides in Surgical Neuropathology Practice Vasculitides in Surgical Neuropathology Practice USCAP requires that all faculty in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS

More information

EULAR Recommendations for Conducting Clinical Studies and/or Clinical Trials in Systemic Vasculitis: Focus on ANCA-associated vasculitis

EULAR Recommendations for Conducting Clinical Studies and/or Clinical Trials in Systemic Vasculitis: Focus on ANCA-associated vasculitis EULAR recommendations for clinical trials in vasculitis 1 EULAR Recommendations for Conducting Clinical Studies and/or Clinical Trials in Systemic Vasculitis: Focus on ANCA-associated vasculitis Bernhard

More information

ANCA-associated systemic vasculitis (AASV)

ANCA-associated systemic vasculitis (AASV) PAPER 2007 Royal College of Physicians of Edinburgh ANCA-associated systemic vasculitis (AASV) 1 DC Kluth, 2 J Hughes 1 Reader in Nephrology, MRC Centre for Inflammation Research, University of Edinburgh,

More information

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB Recent advances in management of Pulmonary Vasculitis Dr Nita MB 23-01-2015 Overview of the seminar Recent classification of Vasculitis What is new in present classification? Trials on remission induction

More information

Efficacy and Safety of Rituximab in the Treatment of Rheumatoid Arthritis and ANCA-associated Vasculitis

Efficacy and Safety of Rituximab in the Treatment of Rheumatoid Arthritis and ANCA-associated Vasculitis New Evidence reports on presentations given at ACR/ARHP 2010 Efficacy and Safety of Rituximab in the Treatment of Rheumatoid Arthritis and ANCA-associated Vasculitis Report on ACR/ARHP 2010 presentations

More information

Vasculitis (Polyarteritis Nodosa, Microscopic Polyangiitis, Wegener s Granulomatosis, Henoch- Schönlein Purpura)

Vasculitis (Polyarteritis Nodosa, Microscopic Polyangiitis, Wegener s Granulomatosis, Henoch- Schönlein Purpura) Vasculitis (Polyarteritis Nodosa, Microscopic Polyangiitis, Wegener s Granulomatosis, Henoch- Schönlein Purpura) J. Charles Jennette Ronald J. Falk The kidneys are affected by a variety of systemic vasculitides

More information

Small-Vessel and Medium-Vessel Vasculitis

Small-Vessel and Medium-Vessel Vasculitis Arthritis & Rheumatism (Arthritis Care & Research) Vol. 57, No. 8, December 15, 2007, pp 1552 1559 DOI 10.1002/art.23105 2007, American College of Rheumatology REVIEW ARTICLE Small-Vessel and Medium-Vessel

More information

4. KIDNEYS AND AUTOIMMUNE DISEASE

4. KIDNEYS AND AUTOIMMUNE DISEASE How to Cite this article: Kidneys and Autoimmune Disease - ejifcc 20/01 2009 http://www.ifcc.org 4. KIDNEYS AND AUTOIMMUNE DISEASE Maksimiljan Gorenjak 4.1 Autoimmune diseases The human immune system limits

More information

Simultaneous comprehensive multiplex autoantibody analysis by CytoBead technology for Rapidly Progressive Glomerulonephritis.

Simultaneous comprehensive multiplex autoantibody analysis by CytoBead technology for Rapidly Progressive Glomerulonephritis. Simultaneous comprehensive multiplex autoantibody analysis by CytoBead technology for Rapidly Progressive Glomerulonephritis l Assays Indirect Immunofluorescence Goldstandard for Diagnosis of Autoimmune

More information

Evidence-based therapy for the ANCAassociated vasculitides: what do the trials. show so far? Clinical Trial Outcomes

Evidence-based therapy for the ANCAassociated vasculitides: what do the trials. show so far? Clinical Trial Outcomes associo far? Evidence-based therapy for the ANCAassociated vasculitides: what do the trials show so far? Anti-neutrophil cytoplasm antibody-associated vasculitides are rare multisystem inflammatory diseases

More information

GRANULOMATOSIS WITH POLYANGIITIS

GRANULOMATOSIS WITH POLYANGIITIS What is granulomatosis with polyangiitis (GPA)? Granulomatosis with polyangiitis (GPA) is a form of vasculitis a family of rare disorders characterized by inflammation of the blood vessels, which can restrict

More information

FAQ Identifying and enrolling participants

FAQ Identifying and enrolling participants FAQ Identifying and enrolling participants WHO IS ELIGIBLE - CASES? Patients with a new diagnosis of primary systemic vasculitis Patients suitable as cases are over 18 years with a new presentation or

More information

A COST EFFECTIVENESS ANALYSIS OF WEEKLY COMPLETE BLOOD COUNT MONITORING FOR LEUKOPENIA IN PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS (GPA) ON

A COST EFFECTIVENESS ANALYSIS OF WEEKLY COMPLETE BLOOD COUNT MONITORING FOR LEUKOPENIA IN PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS (GPA) ON A COST EFFECTIVENESS ANALYSIS OF WEEKLY COMPLETE BLOOD COUNT MONITORING FOR LEUKOPENIA IN PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS (GPA) ON CYCLOPHOSPHAMIDE By ATUL ASHOK KHASNIS, MD Submitted in

More information

Review Article. Current concepts in Anti-Neutrophil Cytoplasmic Antibody (ANCA) associated Vasculitis. Milind Aurangabadkar

Review Article. Current concepts in Anti-Neutrophil Cytoplasmic Antibody (ANCA) associated Vasculitis. Milind Aurangabadkar Review Article Vidarbha Journal of Internal Medicine Volume 23 July 207 Current concepts in Anti-Neutrophil Cytoplasmic Antibody (ANCA) associated Vasculitis Milind Aurangabadkar ABSTRACT Anti-neutrophil

More information

VASCULITIS PRODUCT HIGHLIGHTS

VASCULITIS PRODUCT HIGHLIGHTS VASCULITIS PRODUCT HIGHLIGHTS AESKU.DIAGNOSTICS offers a comprehensive and complete diagnostic portfolio in the field of vasculitis diagnostics. Not only are screening and profiling s available but also

More information

Case Report Testicular Vasculitis: A Sonographic and Pathologic Diagnosis

Case Report Testicular Vasculitis: A Sonographic and Pathologic Diagnosis Hindawi Case Reports in Radiology Volume 2017, Article ID 8923621, 4 pages https://doi.org/10.1155/2017/8923621 Case Report Testicular Vasculitis: A Sonographic and Pathologic Diagnosis Anuj Dixit, 1 Cameron

More information

CENTRAL NERVOUS SYSTEM VASCULITIS

CENTRAL NERVOUS SYSTEM VASCULITIS What is central nervous system (CNS) vasculitis? Central nervous system (CNS) vasculitis is among a family of rare disorders characterized by inflammation of the blood vessels, which restricts blood flow

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,000 116,000 120M Open access books available International authors and editors Downloads Our

More information

EliA MPO S and EliA PR3 S

EliA MPO S and EliA PR3 S Edition 1 2011 n Review ANCA and associated diseases n The Assays EliA MPO S and EliA PR3 S n Experience ANCA testing by high sensitive methods CONTENTS Editorial Some months ago a Swiss colleague sent

More information

Clinical Commissioning Policy: Rituximab For ANCA Vasculitis. December Reference : NHSCB/ A3C/1a

Clinical Commissioning Policy: Rituximab For ANCA Vasculitis. December Reference : NHSCB/ A3C/1a Clinical Commissioning Policy: Rituximab For ANCA Vasculitis December 2012 Reference : NHSCB/ A3C/1a NHS Commissioning Board Clinical Commissioning Policy: Rituximab For The Treatment Of Anti-Neutrophil

More information

Diagnostic Procedures for Vasculitis

Diagnostic Procedures for Vasculitis Diagnostic Procedures for Vasculitis Toshiharu Matsumoto, MD Clinical Professor of Department of Diagnostic Pathology Juntendo University Nerima Hospital, Tokyo, Japan Introduction In 1994, the International

More information

Scleritis LEN V KOH OD

Scleritis LEN V KOH OD Scleritis LEN V KOH OD 2014 PUCO 1 Introduction A painful, destructive, and potentially blinding disorder Highly symptomatic High association with systemic disease Immunosuppresssive agents 2014 PUCO 2

More information

A Dual-Fixed Neutrophil Substrate Improves Interpretation of Antineutrophil Cytoplasmic Antibodies by Indirect Immunofluorescence

A Dual-Fixed Neutrophil Substrate Improves Interpretation of Antineutrophil Cytoplasmic Antibodies by Indirect Immunofluorescence AJCP / Original Article A Dual-Fixed Neutrophil Substrate Improves Interpretation of Antineutrophil Cytoplasmic Antibodies by Indirect Immunofluorescence Ming-Wei Lin, MBBS, 1,2 Roger A. Silvestrini, 1

More information

Is it Autoimmune or NOT! Presented to AONP! October 2015!

Is it Autoimmune or NOT! Presented to AONP! October 2015! Is it Autoimmune or NOT! Presented to AONP! October 2015! Four main jobs of immune system Detects Contains and eliminates Self regulates Protects Innate Immune System! Epithelial cells, phagocytic cells

More information

ARTHRITIS FOUNDATION VASCULITIS

ARTHRITIS FOUNDATION VASCULITIS ARTHRITIS FOUNDATION Registered Nonprofit Organisation - No. 002-847 NPO Helpline No: 0861 30 30 30 VASCULITIS This information leaflet is published by the Arthritis Foundation as part of our continuing

More information

NEWS RELEASE Genentech Contacts: Media: Joe St. Martin (650) Investor: Karl Mahler Thomas Kudsk Larsen (973)

NEWS RELEASE Genentech Contacts: Media: Joe St. Martin (650) Investor: Karl Mahler Thomas Kudsk Larsen (973) NEWS RELEASE Genentech Contacts: Media: Joe St. Martin (650) 467-6800 Investor: Karl Mahler 011 41 61 687 8503 Thomas Kudsk Larsen (973) 235-3655 Biogen Idec Contacts: Media: Christina Chan (781) 464-3260

More information

Vasculitis Update. A selective review of what s new. Dr Jonathan Akikusa MBBS FRACP

Vasculitis Update. A selective review of what s new. Dr Jonathan Akikusa MBBS FRACP Vasculitis Update A selective review of what s new Dr Jonathan Akikusa MBBS FRACP Consultant Paediatric Rheumatologist Royal Children s Hospital, Melbourne Honorary Research Fellow Murdoch Children s Research

More information

Jones slide di 23

Jones slide di 23 1 di 23 The patient with ANCA- associated vasculitis and pulmonary haemorrhage Rachel B Jones, Cambridge, UK Chairs:Hans-Joachim Anders, Munich, Germany Vladimir Tesar, Prague, Czech Republic Prof. Rachel

More information

AN OVERVIEW OF ANCA-ASSOCIATED VASCULITIS

AN OVERVIEW OF ANCA-ASSOCIATED VASCULITIS GRANULOMATOSIS WITH POLYANGIITIS (GPA), MICROSCOPIC POLYANGIITIS (MPA), and EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA) AN OVERVIEW OF ANCA-ASSOCIATED VASCULITIS What is ANCA-associated Vasculitis?

More information

Autoimmune diagnostics. A comprehensive product line for the detection of autoantibodies

Autoimmune diagnostics. A comprehensive product line for the detection of autoantibodies Autoimmune diagnostics A comprehensive product line for the detection of autoantibodies Autoimmune diagnostics Autoimmune diseases are chronic inflammatory processes with an indeterminate etiology. They

More information

Rheumatology. Modern management of primary systemic vasculitis CME: CLINICAL PRACTICE AND ITS BASIS

Rheumatology. Modern management of primary systemic vasculitis CME: CLINICAL PRACTICE AND ITS BASIS CME: CLINICAL PRACTICE AND ITS BASIS Rheumatology Edited by Richard Watts DM FRCP, Consultant Rheumatologist, Ipswich Hospital NHS Trust; Senior Lecturer, School of Medicine, Health Policy, University

More information

29 Glomerular disease: an overview

29 Glomerular disease: an overview 29 Glomerular : an overview Renal Extra-renal Neurological changes Clinical syndromes pressure Sore throat (streptococcal) Rash Cardiac valve lesions Hemoptysis Asymptomatic or Acute Glomerulonephritis

More information

Approach to Glomerular Diseases: Clinical Presentation Nephrotic Syndrome Nephritis

Approach to Glomerular Diseases: Clinical Presentation Nephrotic Syndrome Nephritis GLOMERULONEPHRITIDES Vivette D Agati Jai Radhakrishnan Approach to Glomerular Diseases: Clinical Presentation Nephrotic Syndrome Nephritis Heavy Proteinuria Renal failure Low serum Albumin Hypertension

More information

Crescentic Glomerulonephritis (RPGN)

Crescentic Glomerulonephritis (RPGN) Crescentic Glomerulonephritis (RPGN) Background Rapidly progressive glomerulonephritis (RPGN) is defined as any glomerular disease characterized by extensive crescents (usually >50%) as the principal histologic

More information

RARE JUVENILE PRIMARY SYSTEMIC VASCULITIS

RARE JUVENILE PRIMARY SYSTEMIC VASCULITIS www.pediatric-rheumathology.printo.it RARE JUVENILE PRIMARY SYSTEMIC VASCULITIS WHAT IS IT? Vasculitis is an inflammation of blood vessels. Vasculitides cover a wide group of diseases. Primary vasculitis

More information

Protocol Version 2.0 Synopsis

Protocol Version 2.0 Synopsis Protocol Version 2.0 Synopsis Title Short Title Plasma exchange and glucocorticoid dosing in anti-neutrophil cytoplasm antibody associated vasculitis: a randomized controlled trial. PEXIVAS PEXIVAS Clinical

More information

Diffuse Alveolar Hemorrhage

Diffuse Alveolar Hemorrhage http://dx.doi.org/10.4046/trd.2013.74.4.151 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2013;74:151-162 CopyrightC2013. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights

More information

CHECK LIST FORM-SCREENING

CHECK LIST FORM-SCREENING CHECK LIST FORM-SCREENING Participant Initials: Date of Birth: Evaluation Date: Were the following forms completed for this visit? Eligibility Form Done t Done Baseline medical History Form Done t Done

More information

Kelley's Textbook of Rheumatology. 2 Volume Set. Text with Internet Access Code for Premium Consult Edition

Kelley's Textbook of Rheumatology. 2 Volume Set. Text with Internet Access Code for Premium Consult Edition Kelley's Textbook of Rheumatology. 2 Volume Set. Text with Internet Access Code for Premium Consult Edition Firestein, G ISBN-13: 9781437717389 Table of Contents VOLUME I STRUCTURE AND FUNCTION OF BONE,

More information

Optimizing the Therapeutic Strategies in ANCA-Associated Vasculitis Single Centre Experience with International Randomized Trials

Optimizing the Therapeutic Strategies in ANCA-Associated Vasculitis Single Centre Experience with International Randomized Trials Prague Medical Report / Vol. 107 (2006) No. 2, p. 199 212 199) Optimizing the Therapeutic Strategies in ANCA-Associated Vasculitis Single Centre Experience with International Randomized Trials Vaňková

More information

Rate of infections in severe necrotising vasculitis patients treated with cyclophosphamide induction therapy: a meta-analysis

Rate of infections in severe necrotising vasculitis patients treated with cyclophosphamide induction therapy: a meta-analysis Rate of infections in severe necrotising vasculitis patients treated with cyclophosphamide induction therapy: a meta-analysis M. Jung 1, L. Barra 2 1 Division of Rheumatology, Department of Medicine, University

More information

Glucocorticoids and Relapse and Infection Rates in Anti-Neutrophil Cytoplasmic Antibody Disease

Glucocorticoids and Relapse and Infection Rates in Anti-Neutrophil Cytoplasmic Antibody Disease Article Glucocorticoids and Relapse and Infection Rates in Anti-Neutrophil Cytoplasmic Antibody Disease JulieAnne G. McGregor, Susan L. Hogan, Yichun Hu, Caroline E. Jennette, Ronald J. Falk, and Patrick

More information

Anti-MPO ANCA-Associated Diffuse Alveolar Hemorrhage is Associated with Increased Mortality Compared to Anti-PR3 Disease

Anti-MPO ANCA-Associated Diffuse Alveolar Hemorrhage is Associated with Increased Mortality Compared to Anti-PR3 Disease Anti-MPO ANCA-Associated Diffuse Alveolar Hemorrhage is Associated with Increased Mortality Compared to Anti-PR3 Disease Grace M. Lee, Yara A. Park, Marshall Mazepa, Jay S. Raval Introduction Anti-neutrophil

More information

ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) TESTING GUIDELINES

ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) TESTING GUIDELINES ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) TESTING GUIDELINES Version: 1.0 Ratified by: Clinical Biochemistry Senior Staff Group Date ratified: Name of originator/author: Director responsible for implementation:

More information

Plasma exchanges in ANCA-associated vasculitis

Plasma exchanges in ANCA-associated vasculitis Plasma exchanges in ANCA-associated vasculitis Xavier Puéchal, MD, PhD Centre de Référence des Maladies auto-immunes systémiques rares d Ile de France Hôpital Cochin Université Paris Descartes http://www.vascularites.org

More information

Cerebrovascular Disease

Cerebrovascular Disease Neuropathology lecture series Cerebrovascular Disease Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output: 15-20% Percentage of O 2 consumption (resting):

More information

CHECK LIST FORM-SCREENING

CHECK LIST FORM-SCREENING CHECK LIST FORM-SCREENING Participant Initials: Date of Birth: Evaluation Date: Were the following forms completed for this visit? Eligibility Form Done t Done Baseline medical History Form Done t Done

More information

Clinical characteristics and outcome of vasculitides

Clinical characteristics and outcome of vasculitides GENERAL SECTION ORIGINAL ARTICLE Clinical characteristics and outcome of vasculitides Buddhi Prasad Paudyal, 1 Madhu Gyawalee 2 ISSN: 2091-2749 (Print) 2091-2757 (Online) Correspondence Dr. Buddhi Prasad

More information

CUTANEOUS VASCULITIS. Katharine Warburton ST6 Dermatology

CUTANEOUS VASCULITIS. Katharine Warburton ST6 Dermatology CUTANEOUS VASCULITIS Katharine Warburton ST6 Dermatology AIMS Clinical cases introduction The theory Categorising cutaneous vasculitis Features presenting in the skin Mimics/pitfalls How to initially manage

More information

Assays. New. New. Combinations. Possibilities. Patents: EP , AU

Assays. New. New. Combinations. Possibilities. Patents: EP , AU Assays Patents: EP 2362222, AU 2011217190 New Combinations New Possibilities Technology Classical Handling of Autoimmune Diagnostics 2-Step Diagnostics 1 st Screening 2 nd Confirmation Cell based IFA ELISA

More information

Rayos Prior Authorization Program Summary

Rayos Prior Authorization Program Summary Rayos Prior Authorization Program Summary FDA APPROVED INDICATIONS AND DOSAGE FDA-Approved Indications: 1 Agent Indication Dosage Rayos (prednisone delayedrelease tablet) as an anti-inflammatory or immunosuppressive

More information

Annals of the Rheumatic Diseases 2011; 70(3):

Annals of the Rheumatic Diseases 2011; 70(3): Long-term patient survival in ANCA-associated vasculitis Oliver Floßmann Annelies Berden Kirsten de Groot Chris Hagen Lorraine Harper Caroline Heijl Peter Höglund David Jayne Raashid Luqmani Alfred Mahr

More information