SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

9/19/06

Respiratory system involvement in systemic vasculitis

Summary
Background – The respiratory system (RS) may be involved in different types of systemic vasculitis (SV) to varying degree and frequency.

Findings – The patterns of RS involvement in SV were reviewed by Manganelli et al of the Univ of Parma in Italy. RS involvement is very common in several types of ANCA-positive SV: 1) in Wegeners granulomatous, involvement of the upper and/or lower RS is found in almost every case. The most common chest x-ray findings are solitary or multiple nodules; 2) in Churg-Strauss Syndrome, previous or current asthma is a cardinal symptom. Chest x-rays usually show transient and patchy alveolar infiltrates; 3) in microscopic polyangiitis, diffuse alveolar hemorrhage is the most frequent RS manifestation, presenting as hemoptysis and/or unexplained anemia with bilateral alveolar infiltrates.

In giant cell arteritis, the most frequent respiratory manifestation is a chronic, dry cough. In Takayasu ‘s arteritis asymptomatic pulmonary infiltrates may be seen.

In contrast, RS involvement is very unusual in classic polyarteritis nodosa, cryoblobulinemic vasculitis and Henoch Scholein vasculitis.

Reference
Clin Exp Rheumatol 2006;24:S48-59

Editor's Comments
This discussion highlights possible explanations for a subject of some debate in the past. It does appear that RS involvement is truly unusual in the classic polyarteritis nodosa which involves medium sized arterities and is ANCA-negative. This may be because classic polyarteritis tends to involve that part of the arterial system subject to high blood pressure (more than seen in the pulmonary arterial system).

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