Got any rheum in your this Halloween?
#Vasculitis: a group of multisystem inflammatory conditions with a variety of features depending on size of the vessels

Check out this article & my thread!
https://www.ingentaconnect.com/content/wk/bor/2017/00000029/00000005/art00016
@brownam130
#EmoryACPNP2020 #MakeRheum 1/

History often yields non-specific symptoms such as fever, malaise, & fatigue – not helpful, right? Carve your differential (and then your ) with these clues:
-recent illness
-medication exposure - can cause secondary vasculitis
-the onset/timing of symptoms! 2/

Look at your patient – you may notice:
-painful skin nodules
-purpura
-ulcers

Even spookier - #PediatricVasculitis patients may have cardiovascular changes – look for hypertension and bruits from altered blood flow through the vessel. 3/

Diagnosis is focused on H&P but also can have elevated inflammatory markers – the gold standard being tissue biopsy.
Do you know “witch” of the following is the most common vasculitis in kids? 4/

If you picked “b” as in “boo!” you’re right! Vasculitis is classified by the size of the vessels it affects –
large vessel (like Takayasu)
medium vessel (like Kawasaki)
& lastly small vessel- with #HenochSchonleinPurpura being by far the most common in pediatrics. 5/

Henoch Schonlein Purpura ( #HSP) sounds like the name of a vampire , but it’s actually IgA vasculitis that causes inflammation & bleeding in the small vessels.
It most commonly affects trick-or-treaters ages 3-15 years . 6/

#HSP is usually self-limited (though it has significant morbidity) and can be recognized by
-palpable purpura in patients with neither thrombocytopenia nor coagulopathy
-arthritis
-renal disease
-abdominal pain that can’t be attributed to #toomuchcandy . 7/

Time for #TrickorTreatment - acute, self-limited vasculitis (like HSP) is mostly supportive – hydration, rest, & ibuprofen.
If HSP is still haunting beyond these measures steroids can be used.
Always admit kids with altered mental status, severe pain, or can't drink fluid! 8/

Chronic vasculitis (like Takayasu) should be managed carefully by rheumatology with
-glucocorticoids
-immunosuppressive drugs
-biologic agents.
Unfortunately, well over half relapse . 9/

Once in remission- coach families to monitor for reactivation and drug toxicity. Also, be on the lookout for:
-fever
-claudications
-skin lesions
-headache

Thanks for coming to my Tweetorial – and even though 2020 has major “I got a rock” vibes, have a Happy Halloween! 10/10