Vasculitis Diagnosis and Evaluation

Important blood tests and imaging to find inflammation.

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Vasculitis: Diagnosis and Tests

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Diagnosing vasculitis is notoriously difficult because its symptoms overlap with many other, more common diseases, such as infections and cancers. There is no single test that can confirm all types of vasculitides. Instead, a combination of clinical evaluation, laboratory tests, imaging studies, and tissue biopsies is required. The diagnostic process at Liv Hospital is multidisciplinary, often involving rheumatologists, nephrologists, pulmonologists, and radiologists working together to assemble the clinical puzzle

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Blood Tests

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Inflammatory Markers

Blood tests are used to detect the presence of systemic inflammation, although these are not specific to vasculitis.

  • Erythrocyte Sedimentation Rate: A test that measures how quickly red blood cells settle at the bottom of a test tube. A high rate indicates inflammation.
  • C-Reactive Protein: A protein produced by the liver that rises when there is inflammation in the body.
  • Complete Blood Count: This can reveal anemia (low red blood cells), leukocytosis (high white blood cells), or thrombocytosis (high platelets), all of which are common in active vasculitis.
  • Eosinophils: High levels of eosinophils are a specific marker for Eosinophilic Granulomatosis with Polyangiitis.

Autoantibodies

Specific antibodies help classify the type of vasculitis.

  • ANCA Test: Testing for Antineutrophil Cytoplasmic Antibodies is crucial. A positive result for c-ANCA (PR3) or p-ANCA (MPO) strongly suggests a diagnosis of GPA, MPA, or EGPA.
  • Cryoglobulins: Proteins that clump in the cold, tested for in suspected cryoglobulinemic vasculitis.
  • Viral Serologies: Testing for Hepatitis B and C is routine to rule out infection-associated vasculitis
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Urinalysis and Renal Assessment

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Since the kidneys are frequently a silent target, urine analysis is a critical diagnostic tool.

  • Hematuria: The presence of red blood cells in the urine is a sign of glomerular damage.
  • Red Cell Casts: Clumps of red blood cells viewed under a microscope are a specific sign of glomerulonephritis.
  • Proteinuria: Measuring the amount of protein in the urine helps assess the severity of kidney injury.
  • Creatinine: Blood tests for creatinine levels measure how well the kidneys are filtering waste. Rising creatinine indicates declining kidney function.

Tissue Biopsy

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The Gold Standard

Whenever possible, doctors try to obtain a tissue sample from an affected organ to confirm the diagnosis.

  • Temporal Artery Biopsy: For suspected Giant Cell Arteritis, a small section of the artery at the temple is removed and examined for giant cells and inflammation.
  • Skin Biopsy: A small sample of a rash or ulcer is taken to look for leukocytoclastic vasculitis, characterized by broken white blood cells in the vessel walls.
  • Kidney Biopsy: If kidney tests are abnormal, a needle biopsy of the kidney can determine the extent of inflammation and scarring.
  • Lung Biopsy: In rare cases, a lung sample may be needed to distinguish vasculitis from infection or cancer.

Tissue Biopsy

Visualizing the Vessels

For large and medium vessel vasculitides, visualizing the blood flow is essential.

  • Conventional Angiography: Dye is injected into the blood vessels, and X-rays are taken to look for narrowing, blockages, or aneurysms (bulges). This is particularly useful for Polyarteritis Nodosa.
  • String of Beads: A classic appearance in some vasculitides where the vessel has alternating areas of narrowing and dilation.

Tissue Biopsy Advanced Imaging

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Non-Invasive Assessment

Modern technology allows for detailed imaging without invasive catheters.

  • CT Angiography: Uses CT scanning with contrast dye to create detailed 3D images of blood vessels. It is useful for checking the aorta and lungs.
  • MR Angiography: Uses magnetic resonance imaging to visualize vessels. It is excellent for diagnosing Takayasu arteritis and assessing inflammation in the vessel wall itself.
  • PET CT Scan: This metabolic scan can detect active inflammation in large vessels before structural damage occurs. It is increasingly used to diagnose large vessel vasculitis and monitor treatment response.

Cardiac and Pulmonary Function Tests

  • Echocardiogram: An ultrasound of the heart to check for coronary artery aneurysms (in Kawasaki disease) or other heart involvement.
  • Pulmonary Function Tests: Breathing tests to assess lung capacity and airflow, which can be reduced in lung vasculitis.
  • Bronchoscopy: A flexible tube is passed into the lungs to inspect the airways and take samples, helping to rule out infection or hemorrhage

Differential Diagnosis

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The diagnostic process involves ruling out mimics.

  • Infections: Endocarditis (heart valve infection), tuberculosis, and syphilis can mimic vasculitis.
  • Malignancies: Lymphoma and leukemia can present with similar constitutional symptoms.
  • Drug Reactions: Recent medication changes are reviewed carefully.
  • Clotting Disorders: Conditions that cause blood clots (thrombophilia) can mimic the ischemia seen in vasculitis.

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FREQUENTLY ASKED QUESTIONS

What is the best test for vasculitis?

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