Vasculitis - Causes, Symptoms and Treatment .MF .
Vasculitis - a heterogeneous group of diseases with similar pathogenesis, the structure of which is the basis for multiple lesions of the vascular wall inflammatory, followed by involvement in the inflammatory process of various body systems.Throughout the period of the study group of diseases different scientists have attempted to establish their classification.
causes of vasculitis.
Since the primary veskulity are quite heterogeneous group, difficult to talk about any individual causes of this disease.In most cases the cause is unknown and will not have a significant influence on the course of the pathological process.Infectious theory of the origin of vasculitis remains dominant.In a number of clinical entities have vasculitis chronological connection to a variety of infectious agents.However, it must be remembered that the presence of untreated foci of chronic infection, even if they were the cause of vasculitis can lead to recurrence of the disease and the development of secondary infection, maki
Some causes of vasculitis known for a long time (the effect of various serums and medicines).The role of drugs in the development of vasculitis is not in doubt.Signs of systemic lesions may appear immediately after exposure of the drug to the patient's body or appear as a result of the restructuring of chronic disease drug.Nothing is known more than 150 drugs, the reception of which triggers the development of vasculitis.The most common reaction of this type can receive sports on sulfonamides, antibiotics, iodine preparations, radiopaque substances, vitamins, analgesics, tuberculostatics.We can not exclude a hereditary predisposition, due to a defect of the immune response and altered reactivity of the vessel walls.
Symptoms of vasculitis
principles of clinical diagnosis of vasculitis.
basic principle diagnosis of vasculitis - clinical polymorphism.Early diagnosis is essential for the timely start of treatment, because the later the diagnosis, the more likely the development of irreversible processes in organs and systems.The main role in the diagnosis should be attributed to the clinical manifestations of the disease, ie, complaints and changes detectable during inspection and objective examination of the patient -.. Symptoms.Are important gender of the patient, his age.For example, some forms of vasculitis are ill predominantly male (Buerger's thromboangiitis obliterans), other (non-specific aortoarteritis) - young girls.The defeat of the temporal artery, usually develops in people older than 55 years.Hemorrhagic vasculitis occurs mainly in children or young adults.
Complaints vasculitis patients are diverse and depend on the location of the affected vessel, the phase of the disease and the severity of functional disorders of organs.Of particular importance is the sequence of the onset of symptoms and illness.As a rule, vasculitis start of acute or subacute, with initial signs of inflammation, and the subsequent development of organ pathologies.Among the first symptoms of vasculitis following common nonspecific (or constitutional) and local typical syndromes, which in combination define the clinical picture of a nosology of the disease.
Common symptoms of vasculitis include: weight loss, fever, headache, fatigue.Characterized by a constant low-grade fever, is not reduced in patients receiving antibiotics.The body temperature can drop on their own or in the appointment of glucocorticoids.Weight Loss in some embodiments, is a classic sign of vasculitis, and a significant reduction in body weight in a short period of time is not only a diagnostic value, but is also evidence of disease activity.
cutaneous syndrome is the earliest and varied and the case in 40 - 50% of cases.There may be nodules, petechiae, spots, skin purpura, ulcers.In some cases, there is a mesh pattern on the skin type of marble - net Levidov.Moreover, the intensity of the cyanotic color can vary from mild to severe.This symptom reflects damage vessels in the skin.Most mesh Levidov observed in periarteritis nodosa, Wegener's granulomatosis, and antiphospholipid syndrome.All of these skin lesions may transform into necrotizing form.The image of trophic ulcers are usually painless and have scant discharge.The rate of healing is not so much dependent on local therapy, as the effectiveness of the treatment of vasculitis.In clinical practice, described cases of gangrene of fingers and toes.
Cutaneous manifestations of vascular lesions with vasculitis
pain in the muscles or the so-called Myology, found more than half of the vasculitis and is caused by blood circulation in certain muscle groups.Severe pain in the muscles may precede the development of lesions of the peripheral nervous system, which will manifest itself in the future in violation of the sensitivity of distal fingers and toes.
defeat of the joints is a common symptom.Typically defeat the large joints of the lower and upper extremities - knee, ankle, shoulder.
Renal disease - one of the most frequent adverse prognostic features, is found in 20 - 40% of patients depending on the form of vasculitis.Clinical symptoms of kidney lesions appear at the height of the disease and show nothing of the expressed changes.Also available are various manifestations of the disease of the gastrointestinal tract, the respiratory system and heart.
you should see a doctor rheumatologist if you have any signs of inflammation, such as fever, general weakness, weight loss is not associated with a change of diet.Depending on the localization process in the arterial blood line can be blurred vision, pain in the muscles, blood in urine.
Diagnosis There are no specific laboratory tests for the diagnosis of vasculitis.Basically laboratory changes reflect disease activity (increase otstrofaznyh blood proteins, leukocytes and ESR) and the degree of vascular lesions in individual organs.Great importance is attached to the biopsy site where more pronounced changes.For specific vasculitis has its own peculiarities in diagnostics and clinics.For example, when Wegener's granulomatosis is characterized by a normochromic anemia, moderate leukocytosis without eosinophilia, increased erythrocyte sedimentation rate, thrombocytosis, hypergammaglobulinemia.Acute-phase proteins correspond to disease activity.Can increase immunoglobulins, which largely relates to IgA.Rheumatoid factor is found in more than half of the patients and most often defined in the expanded stage with severe disease activity.For each of the subspecies vasculitis has its own criteria, which is the ratio of their number can say with absolute assurance of the presence or absence of disease.
Treatment of vasculitis
Almost all of vasculitis are chronic progressive disease, when periods of exacerbation are replaced by remissions, which is achieved only targeted treatment.Currently, the key areas of treatment of vasculitis secrete immunosuppression (immunosuppression) and anti-inflammatory medication that is provided by the joint use of glucocorticoids and / or cytotoxic drugs, allowing to limit or interrupt the process of development of immune inflammation.
The drug of choice is prednisone as quickly able to remove swelling of the vascular wall, which reduces the manifestations of ischemic syndrome.However, prolonged use glyukortikosteroidov maintenance dose allows further prevent stenosis of large vessels.
, however, is not contested that the significant improvement in the prognosis for life due to the use of cytotoxic drugs.Cyclophosphamide - dose of the drug can vary quite widely, usually during the initial dose of marked clinical manifestations of the disease is 2 - 3 mg / Ku per day.With a view to intensification of therapy for severe vasculitis torpid course uses a combination of high-dose methylprednisolone and cyclophosphamide 1000 mg intravenously.
good effect in the treatment, as concomitant therapy, give vasodilators (nicotinic acid, persantin, komplamin) and antithrombotic (Courant trental, agapurin) drugs are prescribed long-term rates.
In recent years, widely used methods of extracorporeal blood correction to improve microcirculatory disturbances (plasmapheresis combined with gemoksigenatsiey and ultraviolet blood irradiation).Also, in order to correct microcirculatory disorders based on their driving mechanism causing the following groups of drugs may be used: anticoagulants (direct and indirect) - heparin fraxiparine;methylxanthines - trental, agapurin;a group of non-steroidal anti-inflammatory drugs (low-dose aspirin - 75 - 125 mg / kg).
The active pathogenetic therapy all over the disease can not only extend the life of patients, but also to return some of them to work.This pathology is not treatable herbal drugs, only drugs that are listed here, have a proven, positive effect.
Possible complications of vasculitis:
• syndrome of disseminated intravascular coagulation (DIC)
• Bleeding and thrombosis
• Nephrotic syndrome
• Pulmonary hypertension
• Infectious complications.
This group of diseases is a very high percentage of complications, nachataoe timely treatment can slow down the development of many of them.Patients with vasculitis without specific treatment of immunosuppressive therapy, the prognosis is not favorable, the 5-year survival rate is 10% of the total number of patients.When early active treatment with cytostatics in combination with corticosteroids 5-year survival rate is 60 - 90%.
therapists Zhumagazy EN