# Vasculitis Classification > Vasculitis pathology for MBBS Pathology: giant cell arteritis, Takayasu, polyarteritis nodosa, ANCA-associated disease and IgA vasculitis. - Canonical URL: https://prepelephant.com/topics/mbbs/pathology/vasculitis-pathology - Exam / course: MBBS · Subject: Pathology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Vasculitis Classification", PrepElephant, https://prepelephant.com/topics/mbbs/pathology/vasculitis-pathology ## Direct answer Giant cell arteritis and Takayasu arteritis are the granulomatous large-vessel pair separated by age: above fifty with new headache, jaw claudication, temporal artery tenderness and the threat of sudden blindness, versus below forty — classically a young Indian or East Asian woman — with limb claudication, unequal blood pressures and absent pulses, the pulseless disease. Medium-vessel disease is polyarteritis nodosa, a segmental necrotising arteritis at bifurcations associated with hepatitis B, and Kawasaki disease of children, which steals coronary arteries. The ANCA-associated small-vessel group pairs granulomatosis with polyangiitis (c-ANCA, anti-PR3) with microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (p-ANCA, anti-MPO), and immune-complex disease adds IgA vasculitis of childhood. ## What you must remember - **Giant cell arteritis:** age over fifty, granulomatous inflammation with fragmenting internal elastic lamina; jaw claudication and scalp tenderness; polymyalgia rheumatica association; start high-dose steroid immediately on suspicion — the temporal artery biopsy remains worthwhile for up to about two weeks after steroids begin. - **Takayasu arteritis:** aorta and its branches in women under forty, common in India and East Asia; systemic phase with fever and arthralgia precedes the pulseless phase of claudication, bruits and hypertension from renal artery stenosis; angiography maps the lesions. - **Polyarteritis nodosa:** medium muscular arteries at bifurcations — renal, mesenteric, hepatic and nerve branches; spares the glomeruli and pulmonary arteries, which separates it microscopically from the ANCA group; associated with hepatitis B; does not involve veins. - **Kawasaki disease:** children under five, mucocutaneous fever; coronary artery aneurysms in a quarter untreated — intravenous immunoglobulin 2 grams per kilogram with aspirin is the protocol. - **Granulomatosis with polyangiitis:** c-ANCA against proteinase 3; necrotising granulomas of upper airway (saddle nose) and lung, plus pauci-immune crescentic glomerulonephritis; treated with rituximab or cyclophosphamide plus steroids. - **Microscopic polyangiitis and EGPA:** p-ANCA against myeloperoxidase; polyangiitis without granulomas; eosinophilic granulomatosis adds asthma, eosinophilia and eosinophil-rich granulomas. - **IgA vasculitis (Henoch-Schonlein):** the commonest childhood vasculitis — palpable purpura on buttocks and legs, arthralgia, abdominal pain and IgA nephritis; thrombocytopenia absent (platelets normal, unlike in thrombocytopenic purpura). - **Thromboangiitis obliterans (Buerger disease):** distal arteries of young male smokers, common in India; inflammatory thrombi with giant cells; smoking cessation is the only treatment that changes its course. ## Two pulses worth ninety marks A 24-year-old woman from a village presents with fatigue, weight loss and pain in the arms on use; examination finds the left radial pulse impalpable and a blood pressure differential of 30 millimetres between arms. In an Indian setting this is Takayasu arteritis until angiography proves otherwise — the aortic arch and its branches are stenosing under granulomatous inflammation, and the work-up maps every vessel (renal artery stenosis causing hypertension is the feared complication) before steroids and immunosuppression quiet the systemic phase. Compare the counter-case: a 68-year-old with a new temporal headache, scalp tenderness, jaw pain on chewing and an erythrocyte sedimentation rate of 95; here the emergency is different — the arteritis threatens the posterior ciliary artery and vision, so high-dose prednisolone starts today, on clinical grounds, and the temporal artery biopsy is arranged alongside rather than before treatment, remaining informative for roughly two weeks after steroids begin. Both cases teach the same discipline: age and vessel size first, then the serology. The ANCA pairing completes the toolkit — c-ANCA with proteinase 3 for the airway-and-kidney granulomatous disease, p-ANCA with myeloperoxidase for the renal-limited and asthmatic variants — with the biopsy, when taken, showing pauci-immune vasculitis, meaning scant immunoglobulin deposition. ## Where students slip Delaying steroids for biopsy in suspected giant cell arteritis is the error examiners design questions around; blindness in the waiting period is the permanent complication. Second, palpable purpura in a child is investigated as thrombocytopenia when IgA vasculitis has a normal platelet count — the purpura is inflammatory, not haematological. Third, polyarteritis nodosa is credited with glomerulonephritis; its renal disease is arteritis of the renal artery branches, sparing the glomerular tuft, and pulmonary arteries are spared too — the two histological facts that distinguish it from microscopic polyangiitis in a viva. ## Frequently asked questions ### Which vasculitis occurs above age fifty with jaw claudication and blindness risk? Giant cell (temporal) arteritis — start high-dose corticosteroids immediately; biopsy can wait briefly but not the treatment. ### Which large-vessel vasculitis is common in young Indian women? Takayasu arteritis, the pulseless disease of the aorta and its major branches, with claudication, bruits and renovascular hypertension. ### Which antibody pattern defines granulomatosis with polyangiitis? Circulating c-ANCA against proteinase 3, with necrotising granulomas of airway and lung and crescentic pauci-immune glomerulonephritis. ### Which vasculitis is associated with hepatitis B and spares glomeruli? Polyarteritis nodosa — segmental necrosis of medium muscular arteries at bifurcations, affecting renal and mesenteric branches but not glomerular capillaries or pulmonary arteries. ### Which childhood vasculitis threatens the coronary arteries? Kawasaki disease, treated with intravenous immunoglobulin 2 grams per kilogram and aspirin to prevent coronary aneurysms. ### What is the commonest childhood vasculitis and its tetrad? IgA (Henoch-Schonlein) vasculitis — palpable purpura, arthralgia, abdominal pain and nephritis, with a normal platelet count.