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GPA Damage vs Activity — ESENeph MCQ

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HardRenal VasculitisGPA Damage vs ActivityESENeph

A 62-year-old man with granulomatosis with polyangiitis (GPA, PR3-ANCA positive) in remission develops a saddle-nose deformity and nasal crusting. His renal function is stable. ANCA titres are stable. What is the most likely explanation?

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Correct answer: E — Damage from prior disease (inactive scarring) – not active vasculitis

In GPA, it is important to distinguish disease damage (irreversible scarring from prior inflammation) from active disease (requiring treatment). Saddle-nose deformity and nasal crusting in the context of stable ANCA, stable renal function, and prior GPA history likely represents chronic damage. Active vasculitis would typically show rising ANCA, new systemic symptoms, or declining renal function. Unnecessary intensification of immunosuppression for inactive damage increases infection risk.

Reference: KDIGO 2024 – AAV Guideline; Vasculitis Damage Index