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Vasculitis: causes, symptoms and treatment of the disease

Full nutrition of each cell provides the vascular bed. It has a length of 111 thousand kilometers. It is difficult to imagine such a value.

A significant shock is experienced by the body when this “road of life” is affected. Consider the concept of "vasculitis", what kind of disease and how it should be treated.

Content

Disease vasculitis - what is it?

Many diseases can involve the circulatory system in the pathological process. But more often there is a pathology in which the defeat of the vascular bed will be mandatory, forming part of a single systemic process.

Vasculitis is an inflammation of the arterial or venous vessels of different diameter vessels, which is based on an immunological lesion.

Inflamed vessels are not able to fully feed the organs, over time, their function and structure change. Vasculitis is not a separate disease, rather it is a syndrome, one of the manifestations of a particular disease.

Causes of Vasculitis

Causes of Vasculitis

Symptoms of vasculitis photo

There is no clear explanation of how a disease occurs. There is an assumption that there is a malfunction of the immune system (an autoimmune process). The body produces killer cells, they mistakenly begin to attack the blood vessels.

The starting factor of the perverted process can be an infection, especially a viral one. It has been proven that viruses are able to subdue cells and control their work. Susceptibility to this can be inherited.

Inflammation gradually disables the vessel. The blood supply to the body decreases, hemorrhages, stratifications on the vessel wall and necrosis occur. Without proper nutrition, cells are doomed to death.

Types and forms of the disease

The criteria for the classification of the selected caliber of the vessel, the type of inflammation and the detection of specific antibodies.

There are the following types of vasculitis:

  • damage of large vessels - arteritis;
  • medium caliber vessels - arteriolitis;
  • small vessels or capillary;
  • vasculitis with lesions of various caliber vessels.

By nature, pathology is divided:

Primary - an autonomous disease with vascular lesions.

Secondary - a complication of another disease. For example, against the background of viral hepatitis, secondary vasculitis may appear, which later progresses under the influence of aggressive treatment (medical vasculitis).

Infection (with scarlet fever, typhoid) affects the vessels. Allergic vasculitis (photo above) - from the effects of allergens in allergic diseases. Paraneoplastic vasculitis in oncopathology. Hypersensitivity of the immune system causes serum vasculitis.

The process is subject to any blood vessels of all organs without exception. Many causes serve as a push for the emergence of various forms of vasculitis. Some have a clear causal relationship.

The principle of autoimmune aggression underlies all systemic vascular lesions. This is a hallmark of primary vasculitis.

Arteritis (inflammation of the walls of large vessels) are found:

  • Takayasu disease.

It is characterized by a lesion of the aortic arch and the vessels adjacent to it. The main group consists of young women without atherosclerosis. In this case, the proximal regions of the coronary arteries are affected by vasculitis, and the distal regions are not changed.

Ends aortic insufficiency due to expansion of the aortic root, which leads to angina and heart failure.

  • Giant cell arteritis.

Occurs carotid vasculitis. In the heart, the coronary arteries are targeted. There are cases when the disease suddenly manifested a myocardial infarction.

Older people usually suffer. The clinic has symptoms associated with damage to the arteries leading to the brain - headaches, dysfunction of the lower jaw, neurological abnormalities.

If glucocorticoid therapy gives a good result, then we can safely suspect the disease.

Arteriolitis (damage to medium-sized vessels) is observed:

  • Kawasaki disease - childhood vasculitis.

It is the cause of sudden coronary death and heart attack in children. It occurs with temperature, rash, conjunctivitis, edema, peeling of the skin of the feet and hands. An increase in cervical lymph nodes.

  • Nodular periarteritis - immune complexes in the form of nodules are deposited in the vessels.

There is inflammation and necrosis of small and medium arteries. All this is accompanied by signs of systemic disease. Worried fever, reduced body weight. The kidneys are most often affected, signs of renal failure appear.

Vasculitis of small vessels:

  • Schönlein-Henoch disease.

Vasculitis of small vessels Children suffer. Small hemorrhages appear on the skin, pains in the joints and abdomen bother. Not uncommon gastrointestinal bleeding with glomerulonephritis (kidney damage)

  • Allergic angiitis - eosinophilic granulomatosis and vasculitis.

The appearance of specific anti-cytoplasmic antineutrophil antibodies (ANCA) is characteristic. The disease usually begins with pollinosis or asthma, then the process is generalized, vasculitis joins. Eosinophils increase in blood.

  • Wegener's granulomatosis has a similar pattern.

Small vessels of the respiratory tract and kidneys are affected. Observed pathology of the nose (sinusitis, rhinitis), bronchus (cough, hemoptysis). Over time, kidney failure joins.

  • Essential cryoglobulinemia is a characteristic blockage of vessels with cryoglobulin complexes.

As a result, the vessels become inflamed. Associated with taking antibiotics or other allergens. Patients with hepatitis C often have this type of vasculitis.

There is a rash in the form of urticaria. Inflamed joints, lymph nodes are enlarged, kidneys are affected. Symptoms quickly regress after the elimination of the causative factor.

  • Hyperrheal vasculitis syndrome - cutaneous vasculitis.

Capillaries and skin venules are involved in the inflammatory process. Characteristic rash with areas of small hemorrhages and blisters. Combined with pain in the joints. There is the option of an isolated lesion of the skin in the absence of any other signs of inflammation.

  • Microscopic polyangiitis.

Severe vasculitis with necrosis caused by precipitated immune complexes. More often suffer vessels of the lungs and kidneys. Necrotizing glomerulonephritis and pulmonary capillary develop.

Symptoms of vasculitis in adults

Symptoms of vasculitis in adults

Vasculitis photo

The disease manifests classic signs of inflammation of the body. It has a long course with exacerbations and remissions, often progresses and often ends in disability.

Any vasculitis has characteristic symptoms:

  1. Wave-like rise in temperature;
  2. Weight loss;
  3. Simultaneous inflammation of many organs (systemic) - a rash, hemorrhages on the skin, damage to the kidneys, eyes, lungs, pain in the joints and muscles.

But do not rush to conclusions and the haste of the diagnosis - vasculitis. Until the final decision of the issue is far away. Ahead awaits a thorough differential diagnosis with the obligatory taking of a biopsy of tissues, carrying out laboratory and instrumental tests.

After all, such complaints are found in many diseases. Vasculitis is a rare symptom; experts will not think about it first. A rheumatologist's consultation is always shown.

The clinical picture of vasculitis depends largely on the localization process, the degree of activity of inflammation and the caliber of the affected vessel.

Methods of diagnosis of vasculitis

A careful examination of the doctor and the patient's patience during the examination will help identify the pathology of the vessels with a specific disease. Far from immediately, patients go to a rheumatologist, and this makes it difficult to search.

Sometimes the disease enters the stage of remission and creates the illusion of recovery. At this examination is stopped, and the process progresses.

A presumptive diagnosis must be confirmed by laboratory, morphological and instrumental methods. And only then appoint aggressive therapy.

Laboratory tests will show the presence of specific inflammation. Make a detailed blood test, urinalysis, C – reactive protein.

Serological research significantly helps in making a specific diagnosis.

  • In specialized laboratories, blood is taken for antineutrophilic cytoplasmic antibodies. This helps to detect Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis;
  • Rheumatoid factor - to exclude a rheumatic disease;
  • Cryoglobulins - with primary antiphospholipid syndrome, Goodpasture syndrome. Hepatitis and HIV markers, cytomegalovirus, Epstein – Bar virus are examined.

Instrumental methods

  • Visceral angiography;
  • Doppler ultrasound;
  • R-graphy of the lungs, aortography;
  • Computed and magnetic resonance imaging helps determine the localization process.

For a final diagnosis, a biopsy is needed. Only it allows you to examine in detail the signs of vasculitis, indicate the type and activity of inflammation. It is also important to control the treatment process.

Treatment of vasculitis, drugs and techniques

Vasculitis treatment After the crucial stage of diagnosis and confirmation of the diagnosis, treatment is started. This should be done as quickly as possible. The goal of therapy is to reduce the production of aggressive antibodies, to remove their damaging effects on the vessel, to suppress inflammation.

It is very important to achieve remission and keep it in the future. Previously, this was practically impossible to achieve. Most of the patients died during the first year.

Thanks to modern immunosuppressive therapy (TNF inhibitors, cytostatics), the disease can be defeated or sustained remission is achieved, which is already a victory.

Important: Treatment of systemic vasculitis is strictly individual. Doses are selected carefully based on body weight, age and comorbidities. Often, due to side effects, a vital drug must be removed and replaced with another, while trying not to lose the effect.

Experienced specialists are involved in the treatment and differential diagnosis of vasculitis. Usually it is a rheumatologist and a narrow specialist in the organ that is affected.

The main groups of drugs

Basic:

  • Short-acting glucocorticoids - prednisone;
  • Cytostatics (usually cyclophosphamide, rarely methotrexate and azathioprine)

Auxiliary:

  • Plasmapheresis and hemosorption - avoids renal failure;
  • Cyclosporin A;
  • Immunoglobulin cv;
  • Antiplatelet agents: aspirin, pentoxifylline;
  • Synthetic prostaglandins (misoprostol);
  • Direct anticoagulants;
  • Angiotensin-converting enzyme (ACE) inhibitors;
  • Monoclonal antibodies (Rituximab, Alemtuzumab);
  • Trimethoprim / sulfamethoxazole.

Experimental:

  • Hormones of the genitals;
  • NSAIDs from the COX-2 group - Etoricoxib (Arcoxia);
  • Immunoadhesins;
  • Angiogenesis inhibitors: leflunomide;
  • Inhibitors of tumor necrosis factor - infliximab and adalimumab;
  • Interleukin-5 inhibitor - mepolizumab;
  • B-lymphocyte inhibitors - okrelizumab;
  • Antibodies to B-lymphocyte transmembrane sialoglycoprotein - epratuzumab;
  • B-lymphocyte-stimulating protein antagonist – blisibimod;
  • Stem cell transplantation;
  • Inhibitors of apoptosis.

Surgical treatment is indicated for patients with lesions of large vessels. Sometimes it allows you to save a life. They come to him when the vessels of the heart are affected. Shunting, plastics and other methods give good results.

More often in the treatment of vasculitis use a combination of hormone and cytostatic.

Ointments and creams

External remedies are used in the treatment of secondary vasculitis in the legs. These are creams and ointments with glucocorticoids (ointment "Elokom"), cream with troxevasin.

For the healing of ulcers used ointment "Solcoseryl".

Vasculitis prophylaxis

Prevent the occurrence of primary vasculitis is problematic. It makes sense to strengthen the immune system:

  • Receiving immunomodulators;
  • Hardening of the body: winter swimming, cold douche, swimming.

As for the secondary vasculitis, then its prevention is easier. Elimination of the causes often leads to complete recovery.

In this case, the main recommendations are:

  • Sanitation of chronic foci of infection;
  • Prevent long-term adverse effects of the environment (occupational hazards), poisoning, allergens;
  • Eliminate prolonged stress;
  • Proper nutrition and sleep.

Classification of vasculitis code ICD 10

In the international classification of diseases (ICD 10), vasculitis is indicated under the following codes (depending on the form of manifestation).

  • L95.0 Vasculitis with marble skin (patchy atrophy)
  • L95.1 Erythema elevated resistant
  • L95.8 Other skin limited vasculitis
  • L95.9 Vasculitis, limited to skin, unspecified
  • D69.0, D89.1 - systemic hemorrhagic vascular lesions (allergic purpura, rheumatic purpura, Schönlein-Genoch disease);
  • M30 - Polyarteritis nodosa, as well as related conditions;
  • M30.1 - Granulomatous and allergic angiitis, acute or subacute vasculitis with lung damage;
  • M30.2 - Juvenile polyarteritis;
  • M30.3 - Limfonodular Kawasaki Mucosal Syndrome;
  • M30.8 - Different states of polyarteritis nodosa;
  • M31 - Various necrotizing vasculopathies;
  • M31.0 - Hutspascher syndrome, hypersensitive angiitis;
  • M31.1 - Thrombotic, Thrombocytopenic and Thrombotic Purpura microangiopathy;
  • M31.2 - Fatal middle granuloma;
  • M31.3 - Respiratory necrotizing granulomatosis, Wegener's granulomatosis;
  • M31.4 - Takayasu syndrome (aortic arch);
  • M31.5 - giant cell and rheumatic polymyalgia;
  • M31.6 - giant cell arteritis of other types;
  • M31.8 - Necrotizing vasculopathy refined;
  • M31.9 - Necrotizing vasculopathies, unspecified.

It should be remembered that systemic diseases are difficult to classify, they are still being studied and data are subject to change.

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