Vasculitis: symptoms and treatment
"Vasculitis" is a general term combining a number of diseases characterized by inflammation of the vascular walls.With such pathologies, the blood vessels narrow, and the supply and supply of tissues with oxygen deteriorates.The consequence is often the death of tissues and a sharp decline in the functional activity of individual organs, until their complete failure.
The treatment of vasculitis is mainly done by specialists in rheumatology, but the variety of clinical manifestations often requires examination by physicians of other specializations.Table of contents: Classification Why do vasculitis develop?Symptoms of vasculitis Treatment of vasculitis, prognosis and prevention Prognosis Prophylaxis
According to the accepted classification, primary and secondary varieties of inflammatory lesions of the vascular walls are isolated.
Depending on the type of vessels affected by the inflammatory process, vasculitis is divided into:
- arteritis( major arteries suffer;
- arteriolitis( affected arterioles);
- phlebitis( inflamed veins);
- capillaryritis( small blood vessels are affected).
The following diseases are attributed to the vasculitis group:
- hemorrhagic vasculitis( Schonlein-Genoch syndrome);
- Takayasu disease( nonspecific aortoarteriitis);
- microscopic polyangiitis;
- Kawasaki disease;
- mixed vasculitis;
- nodular polyarteritis;
- skin allergic skin;
- Behcet's disease;
- Horton's disease( giant cell vasculitis);
- Wegener's granulomatosis;
- cryoglobulinemic vasculitis.
Why do vasculitis develop?
Primary vasculitis is considered by specialists as an independent nosological form.The exact causes of this disease are still unclear.
Secondary lesions of the vascular walls develop against the backdrop of a wide variety of pathologies.
Possible causes of secondary vasculitis:
- infections( both acute and chronic);
- individual reaction of the body to the introduction of vaccines( serums);
- contact with chemicals or biological poisons;
- genetic factor( hereditary predisposition);
- thermal factor( overheating or hypothermia of the body);
- skin burns( including against the background of long-term insolation);
- trauma of various genesis and localization.
Important: Vasculitis often develops in individuals who have experienced viral hepatitis.
Any of these factors, as well as a combination of two or more of them, is able to change the antigenic structure of the body's own tissues, in this case - the walls of the vessels.The immune system begins to perceive them as foreign, and activates the production of antibodies, which additionally damage the blood vessels.Thus, an autoimmune reaction is triggered, in which inflammatory-degenerative processes develop in the target tissues.
Symptoms of vasculitis
Clinical manifestations of pathologies of this group largely depend on the nature of the disease, i.e., specific nosological form.Some vasculitis affects only the skin, causing the patient only minor discomfort.Others cause multiple injuries to internal organs, leading to death of a person.
A common for all vasculitis symptom is a more or less pronounced febrile reaction.A rise in body temperature is a typical reaction of the body to a serious inflammation of any localization of .Hyperthermia can be unstable;Daily fluctuations in temperature are typical for inflammation of blood vessels.At the peak of its increase, often a skin reaction develops in the form of rashes.
Other symptoms often seen in patients with vasculitis include:
- general weakness;
- marked physical and mental fatigue;
- pallor of the skin;
- myalgia( characteristic of the nodular form);
- paresthesia( impaired sensitivity);
- drop in visual acuity;
- periodic loss of consciousness( fainting);
- deterioration or total absence of appetite;
- sleep disorders;
- neuropsychiatric disorders;
- frequent inflammation of the oral mucosa;
- swelling in the temporal region( characteristic of Horton's disease);
- appearance of non-infection ulcerative lesions on the genitals( with Behcet's syndrome).
Typical clinical manifestations of vasculitis include small area hemorrhages with primary localization on the skin of various parts of the body. As the process progresses, they appear in muscle tissue, articular cavities and in areas of nerve endings.
Depending on which vessels are affected, a particular organ suffers predominantly.If kidney vessels have suffered, glomerulonephritis, pyelonephritis and infarcts of the kidney often develop.With the localization of inflammation in the coronary arteries, the risk of heart damage( up to the infarction caused by ischemia) is high.When the vessels that feed the articular tissues are affected, the symptoms of arthritis primarily develop, and other signs may appear only after a few weeks or even months.
Note: for arthritis caused by eating disorders and tissue oxygenation is characterized by the development of a pain syndrome not associated with increased physical exertion or trauma.On the background of vasculitis, inflammation usually develops in large joints.
A characteristic symptom of one of the most common vasculitides - hemorrhagic - is palpable purpura.These are skin rashes in the form of small hemorrhages with predominant localization on the folds of the limbs.Often revealed abdominal syndrome, which is characterized by intense pain in the abdominal region.
When cardiovascular disease occurs, cardialgia, shortness of breath and heart rhythm disturbances appear.
Wegener's granulomatosis is characterized by a predominant lesion of nasal sinuses with the release of blood and pus from the nasal passages.
For any pathology of this group, a typically protracted chronic course with inevitable progression in the absence of treatment. They are also characterized by periodic exacerbations, during which the severity of clinical symptoms is increasing.
In the course of laboratory diagnostics, a decrease in the level of hemoglobin( anemia) and a moderate increase in the number of leukocytes and platelets are often detected in the blood.
In the urine, blood cells are formed( leukocytes and erythrocytes), that is, there is a microhematuria;Often found and protein.
Clinical symptoms are mostly non-specific, therefore, a number of laboratory tests are required to diagnose the inflammation and autoimmune process, as well as apparatus methods of investigation - ultrasound, fluoroscopy, computed tomography and MRI.If necessary, tissue biopsy is performed.
Treatment of vasculitis, prognosis and prevention
Therapeutic tactics are selected for each patient individually.When formulating a treatment plan, the form of vasculitis, the severity of the course of the process and the presence of concomitant pathologies are taken into account.
The main tasks of treatment for vasculitis:
- achieving remission;
- relapse prevention;
- prevention of irreversible damage to organs and tissues;
- reduced probability of complications;
- increases the duration and quality of life of the patient.
The basis of vasculitis treatment is pharmacotherapy.The patient is prescribed drugs that reduce the sensitivity of tissues and reduce the synthesis of antibodies .In particular, glucocorticoid hormones are shown.It is hormonal therapy that allows for a short time to suppress the abnormal activity of the immune system.If in the complicated course of the disease it is not possible to achieve positive results with glucocorticoids, chemotherapy with the use of cytostatics is indicated.
If a hemorrhagic variety of pathology is diagnosed, rational antibiotic therapy becomes a prerequisite for successful treatment.
A good therapeutic effect in most cases can be achieved with the help of blood purification through plasmapheresis and hemosorption techniques.
For mild disease and remission, drugs from the NSAID group( non-steroidal anti-inflammatory drugs) are used.Patients, in particular, are assigned Voltaren and Indomethacin, allowing, among other things, to reduce the intensity of the pain syndrome.
Vasculitis shows drugs that reduce the degree of permeability of the vascular walls and inhibit the process of thrombus formation.
Note: treatment of allergic vasculitis, in which only minor skin lesions are detected, possibly without the use of pharmacological agents.In this case, the elimination of the patient's contact with the putative allergen is at the forefront.
The prognosis largely depends on the localization and severity of the inflammation of the vessels, as well as on the number of affected organs.
Hardening procedures are recommended to prevent vascular inflammation.One of the important preventive measures is to reduce the influence of unfavorable external factors on the body and normalize sleep and rest.Do not take pharmacological drugs without prescribing a doctor or go through the vaccine unnecessarily.All vaccines a person should receive in accordance with the National Vaccination Calendar.
Elena Sovinskaya, medical reviewer