| Granulomatosis with polyangiitis 81 82
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Commonly occurs in older adults Prodromal: fever, malaise, anorexia, weight loss Recurrent sinusitis, epistaxis, scleritis (more common than uveitis), otitis media, polychondritis, oral and/or nasal ulcers, cough, haemoptysis, abnormal chest radiograph (nodules, fixed infiltrates, cavities), abnormal urinary sediment (microscopic haematuria), leucocytoclastic angiitis, conjunctivitis, corneal ulcerations, scleritis, optic neuropathy, retinal vasculitis, and uveitis, inflammatory pseudotumours, arthritis, granulomatous inflammation on biopsy of an artery or perivascular area
Uncommon presentations involve the gastrointestinal tract, heart, lower genitourinary tract (including ureters and prostate), parotid glands, thyroid, liver or breast
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| Eosinophilic granulomatosis with polyangiitis83 84
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Prodromal phase: adult-onset (20s–30s) of atopic disease, allergic rhinitis, asthma Eosinophilic phase: peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, especially the lung and gastrointestinal tract. Pulmonary opacities, asthma and peripheral eosinophilia are present in about 40% of patients Vasculitic phase: systemic vasculitis of small and medium vessels, associated with vascular and extravascular granulomatosis. The vasculitis phase is often heralded by constitutional symptoms and signs
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| Polyarteritis nodosa85
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Affects middle-aged or older adults, with male predominance Though most cases are idiopathic, there are associations with hepatitis B and hepatitis C The cardinal features of classic polyarteritis nodosa include renal infarcts, renal artery stenosis and visceral microaneurysms Clinical presentations: constitutional symptoms, mononeuritis multiplex, arthralgia/myalgia, livedo reticularis, purpura and cutaneous ulcers, new-onset hypertension, lung infiltrates (rare), stroke, limb claudication or ischaemia
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| Giant cell arteritis/temporal arteritis |
Older adults Often presents with constitutional symptoms Clinical manifestations: anaemia, thrombocytosis, fever, jaw claudication, scalp tenderness, amaurosis fugax, arthritis, aortitis, stroke
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| Systemic lupus erythematosus |
Usually affects ladies of reproductive age May affect any organ system Photosensitivity, alopecia, recurrent oral ulcers, arthralgia/arthritis, tenosynovitis, cytopenia, sicca, serositis, myalgia/myositis, microscopic haematuria, proteinuria, oedema, cutaneous lupus May present with lupus hepatitis and lymphadenopathy
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| Rheumatoid arthritis |
Symmetrical erosive polyarthritis predominantly affecting the small joints of hands and feet May be complicated by extra-articular manifestations (ocular, vasculitis)
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