Large and medium vessel vasculitis (GCA, Takayasu, PAN, Kawasaki disease)

Condition

Key features

Treatment

Giant cell arteritis

Over 50 years; new headache, jaw claudication, visual loss, scalp tenderness; temporal artery biopsy/ultrasound, raised ESR/CRP

A: Prednisone 1–2 mg/kg/day, taper after 4–6 weeks, AND S: methotrexate 15–25 mg weekly, OR S: tocilizumab 8 mg/kg IV every 4 weeks (refractory). Treat early – risk of blindness

Takayasu arteritis

Young women; limb claudication, absent pulses, BP difference, renovascular hypertension; CT/MR angiography

A: Prednisone 1–2 mg/kg/day, taper after 4–6 weeks, AND S: methotrexate 15–25 mg weekly, OR S: azathioprine 2 mg/kg/day for maintenance

Polyarteritis nodosa

Adults 40–60; fever, weight loss, hypertension, renal infarction, abdominal pain, neuropathy, livedo, testicular pain; hepatitis B link

A: Prednisolone 1–2 mg/kg/day, taper after 4–6 weeks, AND S: cyclophosphamide 1–2 mg/kg/day PO or IV pulses ± plasma exchange

Kawasaki disease

Children under 5; fever over 5 days, conjunctivitis, strawberry tongue, rash, hand/foot changes, neck nodes; echo for coronary aneurysms

S: IV immunoglobulin 2 g/kg single infusion AND A: aspirin 80–100 mg/kg/day in the febrile phase, then 3–5 mg/kg/day; S: prednisolone 2 mg/kg/day for IVIG-resistant or high-risk cases