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SNOWMASS, COLO. — The most common pitfall in diagnosing vasculitides is failure to ask about the size of the involved blood vessels, Dr. John H. Stone said at a symposium sponsored by the American College of Rheumatology.
“That's really the key to sorting out these diseases clinically,” said Dr. Stone, a rheumatologist at Massachusetts General Hospital in Boston.
Large-vessel diseases can be excluded because vessels larger than 150 mcm are not present in the skin and very rarely lead to cutaneous findings. Medium-size vessels (50–150 mcm) have muscular walls, and some can be visualized. Small vessels (under 50 mcm) can't be visualized.
Vasculitides can be classified by the size of involved vessels: pure small vessel, pure medium vessel, and small/medium vessel overlap, he said.
Pure small-vessel vasculitides include Henoch-Schönlein purpura, hypersensitivity vasculitis, and hypocomplementemic urticarial vasculitis. Signs include palpable and nonpalpable purpura, pustules, urticarial lesions, and blisters.
Pure medium-vessel vasculitides include polyarteritis nodosa and Buerger's disease. Medium-vessel lesions include nodules, ulcers, livedo reticularis, and digital ischemia. “Medium-size vessels, down deep in the dermis and in the fat, cause skin lesions that typically heal with scarring,” said Dr. Stone.
There are two categories of small/medium vessel vasculitides: antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides and cryoglobulinemia. ANCA-associated vasculitides include Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and drug-induced ANCA-associated vasculitis.
SNOWMASS, COLO. — The most common pitfall in diagnosing vasculitides is failure to ask about the size of the involved blood vessels, Dr. John H. Stone said at a symposium sponsored by the American College of Rheumatology.
“That's really the key to sorting out these diseases clinically,” said Dr. Stone, a rheumatologist at Massachusetts General Hospital in Boston.
Large-vessel diseases can be excluded because vessels larger than 150 mcm are not present in the skin and very rarely lead to cutaneous findings. Medium-size vessels (50–150 mcm) have muscular walls, and some can be visualized. Small vessels (under 50 mcm) can't be visualized.
Vasculitides can be classified by the size of involved vessels: pure small vessel, pure medium vessel, and small/medium vessel overlap, he said.
Pure small-vessel vasculitides include Henoch-Schönlein purpura, hypersensitivity vasculitis, and hypocomplementemic urticarial vasculitis. Signs include palpable and nonpalpable purpura, pustules, urticarial lesions, and blisters.
Pure medium-vessel vasculitides include polyarteritis nodosa and Buerger's disease. Medium-vessel lesions include nodules, ulcers, livedo reticularis, and digital ischemia. “Medium-size vessels, down deep in the dermis and in the fat, cause skin lesions that typically heal with scarring,” said Dr. Stone.
There are two categories of small/medium vessel vasculitides: antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides and cryoglobulinemia. ANCA-associated vasculitides include Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and drug-induced ANCA-associated vasculitis.
SNOWMASS, COLO. — The most common pitfall in diagnosing vasculitides is failure to ask about the size of the involved blood vessels, Dr. John H. Stone said at a symposium sponsored by the American College of Rheumatology.
“That's really the key to sorting out these diseases clinically,” said Dr. Stone, a rheumatologist at Massachusetts General Hospital in Boston.
Large-vessel diseases can be excluded because vessels larger than 150 mcm are not present in the skin and very rarely lead to cutaneous findings. Medium-size vessels (50–150 mcm) have muscular walls, and some can be visualized. Small vessels (under 50 mcm) can't be visualized.
Vasculitides can be classified by the size of involved vessels: pure small vessel, pure medium vessel, and small/medium vessel overlap, he said.
Pure small-vessel vasculitides include Henoch-Schönlein purpura, hypersensitivity vasculitis, and hypocomplementemic urticarial vasculitis. Signs include palpable and nonpalpable purpura, pustules, urticarial lesions, and blisters.
Pure medium-vessel vasculitides include polyarteritis nodosa and Buerger's disease. Medium-vessel lesions include nodules, ulcers, livedo reticularis, and digital ischemia. “Medium-size vessels, down deep in the dermis and in the fat, cause skin lesions that typically heal with scarring,” said Dr. Stone.
There are two categories of small/medium vessel vasculitides: antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides and cryoglobulinemia. ANCA-associated vasculitides include Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and drug-induced ANCA-associated vasculitis.