skip to main content

GPA Damage vs Activity Saddle Nose Assessment — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRenal VasculitisGPA Damage vs Activity Saddle Nose AssessmentESENeph

A 45-year-old man with granulomatosis with polyangiitis (GPA) on maintenance rituximab develops a new saddle-nose deformity and nasal crusting. His ANCA is negative and CRP is normal. eGFR is stable at 55 mL/min/1.73m2. Urinalysis is bland. What does this new nasal deformity most likely represent?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Accumulated structural damage from previous active disease (damage vs activity)

In AAV/GPA, distinguishing disease ACTIVITY from disease DAMAGE is critical. The new saddle-nose deformity with negative ANCA, normal CRP, stable renal function, and bland urine suggests structural damage from previous cartilage destruction rather than active vasculitis. The Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) are separate assessment tools. Damage items (saddle nose, nasal septal perforation, hearing loss, scarring) are irreversible consequences of prior disease activity and do NOT indicate current active vasculitis. Escalating immunosuppression for damage items exposes patients to toxicity without benefit. Management is surgical/reconstructive (e.g., saddle-nose repair by ENT) rather than immunological.

Reference: KDIGO 2024 – AAV Guideline; Exley et al 1997 – VDI Development; JRCPTB 2022