Integrating the Consideration of Mimics Into the Evaluation of Suspected Vasculitis

In this video, Tanaz A. Kermani, MD, describes how rheumatologists should integrate the consideration of mimics into their evaluation of suspected vasculitis. She also offers advice as to how they should go about differentiating vasculitis from its mimics as well as what a rheumatologist’s next step should be if they do in fact identify a vasculitis mimic.

Tanaz A. Kermani, MD, is the founder and director of the multidisciplinary Vasculitis Program at the University of California, Los Angeles. There, she also serves as the associate clinical professor in the Division of Rheumatology. 

Additional Resource:

Maningding E, Kermani TA. Mimics of vasculitis. Rheumatology (Oxford). 2021;60(1):34-47. doi:10.1093/rheumatology/keaa495 

TRANSCRIPT:

Tanaz Kermani:  How do we integrate our differential for mimics when we're evaluating patients with vasculitis? What should be our next steps if we identify a vasculitis mimic?

The main way to avoid the pitfall of missing a mimic is to keep a broad differential and also to take time to gather necessary information. The evaluation of any patient with vasculitis should consider mimics.

As in the case of vasculitis, an approach to mimics based on the anatomic size of the vessel that is being affected can be useful. For example, the vasculopathies are important to consider when evaluating patients with large- and medium-vessel vasculitis. Infections can mimic vasculitis of any size. Cholesterol emboli, thrombotic conditions typically mimic the manifestations of medium- and small-vessel vasculitis.

Once a mimic is identified, it is important to refer the person to the appropriate specialist, if appropriate, to evaluate the patient. There are some cases where there is a lot of uncertainty, we're not certain about what the underlying diagnosis is even after taking all the necessary steps.

In these cases, usually making a decision about treatment, then following the patient over time and reassessing the diagnosis periodically, also reassessing any new information or new areas that can be affected, and the clinical course can be helpful.