Granulomatosis with polyangiitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Obtaining a complete history is an important aspect in making a clinical diagnosis of Granulomatosis with polyangiitis. As it can help aid in differentiating between the ANCA associated vacuities and other possible causes that may mimic the disease.There are many similarities that are present between ANCA associated vacuities and Granulomatosis with polyangiitis. A history and physical can help assess the disease.
History
Obtaining a complete history is an important aspect in making a clinical diagnosis of Granulomatosis with polyangiitis. As it can help aid in differentiating between the ANCA associated vacuities and other possible causes that may mimic the disease. There are many similarities that are present between ANCA associated vacuities and Granulomatosis with polyangiitis. A history and physical can assess the disease. The initial common signs that are present in patients with Granulomatosis with polyangiitis are non-specific in nature. The most common complaints are constitutional symptoms such as:[1]
- malaise
- pyrexia
- weight loss
- arthralgia
- cough
- dyspnea
- purpura
- abnormal urinary sediment
Ear, nose and throat involvement:
- nasal crusting
- sinusitis
- otitis media
- otorrhea
- epistaxis
- ulcers of the oral cavity or nasal
- conductive and or sensorineural hearing loss
- saddle nose deformity
- masses present in the upper airway
- cranial nerve entrapment
Pulmonary involvement:
- hoarseness
- cough
- dyspnea
- stridor
- hemoptysis
- pulmonary fibrosis
- pulmonary arterial hypertension
- parenchymal lung nodules
Renal involvement:
- glomerulonephritis
- hematuria
- rise in serum creatinine
- edema
- hypertension
- red cell cast
Cutaneous involvement:
- leukocytoclastic angiitis
- livedo reticularis
Ophthalmic involvement:
- conjunctivitis
A diagnosis of Granulomatosis with polyangiitis can be made when three out of six criteria are established:[2]
- a histopathology that shows granuloma
- the upper respiratory tract is involved
- there is a stenosis that is present in larynx, trachea, and the bronchioles
- the pulmonary system is involved
- the presence of anti-neutrophil cytoplasmic antibodies
- the presence of glomerulonephritis
Initial signs are protean, and diagnosis can be severely delayed due to the non-specific nature of the symptoms. The rhinitis is generally the first sign in most patients.
- Upper airway, eye and ear disease:
- Nose: pain, stuffiness, nosebleeds, rhinitis, crusting, saddle-nose deformity due to aperforated septum
- Ears: conductive hearing loss due to Eustachian tube dysfunction, sensorineural hearing loss (unclear mechanism)
- Eyes: pseudotumours, scleritis, conjunctivitis, uveitis, episcleritis
- Airways:
- Trachea: subglottal stenosis
- Lungs: pulmonary nodules (referred to as "coin lesions"), infiltrates (often interpreted aspneumonia), cavitary lesions, pulmonary hemorrhage causing hemoptysis), and rarely bronchial stenosis.
- Kidney: rapidly progressive segmental necrotising glomerulonephritis (75%), leading tochronic renal failure
- Arthritis: Pain or swelling (60%), often initially diagnosed as rheumatoid arthritis
- Skin: nodules on the elbow, purpura, various others (see cutaneous vasculitis)
- Nervous system: occasionally sensory neuropathy (10%) and rarely mononeuritis multiplex
- Heart, gastrointestinal tract, brain other organs: rarely affected.
Symptoms
The first symptoms of Wegener's granulomatosis are often vague and frequently include upper respiratory tract symptoms, joint pains, weakness, and tiredness.
Upper respiratory tract
The most common sign of Wegener's granulomatosis is involvement of the upper respiratory tract, which occurs in nearly all patients. Symptoms include sinus pain, discolored or bloody fluid from the nose, and, occasionally, nasal ulcers. A common sign of the disease is almost constant rhinorrhea ("runny nose") or other cold symptoms that do not respond to usual treatment or that become increasingly worse.
Rhinorrhea can result from nasal inflammation or sinus drainage and can cause pain. A hole may develop in the cartilage of the nose, which may lead to collapse (called saddle-nose deformity). The eustachian tubes, which are important for normal ear function, may become blocked, causing chronic ear problems and hearing loss. Bacterial infection can cause Wegener's-related sinusitis (inflammation of the sinuses) with congestion and chronic sinus pain.
Lungs
The lungs are affected in most people with Wegener's granulomatosis, although no symptoms may be present. If symptoms are present, they include cough, hemoptysis (coughing up blood), shortness of breath, and chest discomfort.
Kidneys
Kidney involvement, which occurs in more than three-fourths of people with this disorder, usually does not cause symptoms. If detected by blood and urine tests, a doctor can start proper treatment, preventing long-term damage to the kidneys.
Musculoskeletal system
Pain in the muscles and joints or, occasionally, joint swelling affects two-thirds of people with Wegener's granulomatosis. Although joint pain can be very uncomfortable, it does not lead to permanent joint damage or deformities.
Eyes
Wegener's granulomatosis can affect the eyes in several ways. People may develop;
- Conjunctivitis (inflammation of the conjunctiva, the inner lining of the eyelid)
- Scleritis (inflammation of the scleral layer, the white part of the eyeball)
- Episcleritis (inflammation of the episcleral layer, the outer surface of the sclera)
- Mass lesion behind the eye globe
Symptoms in the eye include redness, burning, or pain. Double vision or a decrease in vision are serious symptoms requiring immediate medical attention.
Skin lesions
Nearly half of people with Wegener's granulomatosis develop skin lesions. These often have the appearance of small red or purple raised areas or blister-like lesions, ulcers, or nodules that may or may not be painful.
Other symptoms
Some people experience narrowing of the trachea. The symptoms can include voice change, hoarseness, shortness of breath, or cough.
The nervous system and heart occasionally may be affected. Fever and night sweats may occur. Fever also may signal an infection, often of the upper respiratory tract.
References
- ↑ Fauci AS, Haynes BF, Katz P, Wolff SM (1983). "Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years". Ann Intern Med. 98 (1): 76–85. PMID 6336643.
- ↑ Noone D, Hebert D, Licht C (2016). "Pathogenesis and treatment of ANCA-associated vasculitis-a role for complement". Pediatr Nephrol. ( ): . doi:10.1007/s00467-016-3475-5. PMID 27596099.