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Classification and treatment of systemic vasculitis
Systemic vasculitis is a disease characterized by inflammation and subsequent degenerative destruction of the walls of blood vascular. This causes ischemia of organs and tissues by disrupting their blood supply.
Classification of vasculitis
Disease gradious the types that require different approaches to the treatment of the disease. Here the classification of systemic vasculitis:
- Takayasu's Disease;
- Thromboangiitis obliterans;
- Temporal arteritis;
- Wegener's Granulomatosis;
- Behçet's Syndrome;
- Periarteritis nodosa.
Disease Takayasu inflammation of the aorta and large arteries, and in temporal arteritis affects the large vascular, in 90% of cases, head. Wegener's granulomatosis is characterized by loss of renal vascular, upper respiratory tract and lung tissue, when Behcet's syndrome is inflammation of the mucous membranes of the eyes and genitals.
When nodular periarteritis large vascular are not subject to inflammation, but affects the small and sometimes medium-sized arteries, thromboangiitis obliterans is characterized by lesions of the veins and arteries of the muscles.
The sooner the disease is detected, the more effective its treatment, and the therapy less long.
Symptoms
Symptoms of systemic vasculitis is different. Their study helps your doctor faster to diagnose the disease and begin effective treatment.
Periarteritis nodosa often affects the blood vascular of men.
Symptoms:
- Weight loss;
- Muscle pain;
- Temperature rise;
- Nausea.
Delayed treatment of periarteritis nodosa leads to mental disorders and strokes, so the doctor is important to quickly diagnose and begin treatment.
Symptoms of Wegener's granulomatosis have pronounced it:
- Purulent discharge from the upper respiratory tract;
- Pain in okolonosovyh sinus;
- The deformation of the cartilage of the nose;
- Shortness of breath and cough;
- Renal failure.
Some symptoms may dominate, while others are virtually absent.
The symptoms of temporal arteritis:
- Weakness;
- Fever;
- Headache;
- The reduction of mass;
- Swelling in the temples.
The main group of cases - people who have reached the threshold of 60 years.
In nonspecific aortoarteritis are concerned:
- Vision problems;
- Numbness of limbs;
- Pain (back, abdomen and heart area);
- Brief loss of consciousness.
Most often disease of the aortic type affects the aortic arch and arteries, from her waste, which reduces blood flow to the head and upper torso. Women young and middle-age most susceptible to the disease, men diagnosed with nonspecific aortoarteritis less.
To achieve remission more often used indomethacin and recommended long-term treatment.
Symptoms of thromboangiitis obliterans regardless of what vascular were exposed to the disease. Often the patient suffers from numbness of the limbs and lameness, often reveals thrombophlebitis. Patients are mostly young men, but increases the number of cases of women that doctors associated with the popularity of Smoking among representatives of the weaker sex.
The best means of prevention of obliterans is a rejection of alcohol and Smoking, and minimizing exposure. The treatment uses hormones that suppress inflammation and dilate the blood vascular.
The main symptom in behçet's syndrome - stomatitis, second, and third place is shared by ulcer on the genital mucosa affected patients and inflammation of the eye. Of diseases affecting the eye, most frequently bilateral uveitis, however, it rarely starts at the beginning of the disease.
The diagnosis is important to consult an ophthalmologist and the study of eye after injection of fluorescein.
The second most common concomitant disease is conjunctivitis, rarely diagnosed vasculitis and neuritis nerve of the eye.
Lesions of the retina often reversible, but in severe form of the disease can be major changes that can lead to glaucoma and cataracts.
When analysis is set to increase in serum immunoglobulin.
For accurate diagnosis a rheumatologist considers all patient complaints, but not enough to start treatment and the patient has to undergo a full course of diagnostics.
Diagnosis
For successful treatment, correct diagnosis of systemic vasculitis. This will allow to choose optimal treatment and to avoid complications. The disease can be primary and secondary.
Primary vasculitis is a separate process that is not worth other diseases, and secondary systemic vasculitis occurs in the background of other diseases of infectious or oncologic nature.
From diseases that can cause secondary vasculitis, select:
- Scarlet fever;
- Meningitis;
- Sepsis;
- Psoriasis;
- Of the tumor.
For accurate diagnosis, diagnosis includes:
- A chest x-ray;
- ECG;
- Ultrasound examination of the kidneys;
- Echocardiography;
- Laboratory tests.
Special attention in analysis is paid to the levels of ESR, fibrinogen and protein.
It should be a survey of doctors: neurologist, and rheumatologist, as well as angiography of the vascular. A required step when vasculitis is biopsy of diseased organs and laboratory study of the affected tissues.
Vasculitis in children
Meet systemic vasculitis in children aged from a few months (Kawasaki syndrome) and 18. Diagnosis and treatment of the disease in children are the same as in adults, there is a difference only in dosages drugs for.
Kawasaki syndrome occurs in children up to 5 years, disease, Shenleyn-Schonlein purpura affects children aged 4 to 14 years, and nonspecific aortoarteritis occurs in adolescents after 10 years. Boys and girls are prone to vasculitis equally.
Causes of diseases of children 100% unknown, but it is believed that vasculitis cause hepatitis and bacterial infections, in particular streptococcal.
Is having a negative effect and allergies, which creates the background for disease and causes desensitization of an organism. These two factors: allergies and viral (bacterial) infections act as trigger points and can cause of vascular diseases even at an early age.
In children, as in adults, the degree of vascular disorders directly dependent on the level of collateral circulation and the size of the affected vascular and arteries. The stenosis and occlusion of the artery causes proliferative segmental inflammation, and the change of state receptacle can be varied - necrosis, infarction, ischemia, and so on.
Treatment
Treatment of systemic vasculitis consists of several stages:
- Suppression of the immune response to induce remission;
- Therapy support immunosuppressants;
- The access to the stable remission;
- Diagnosis organ damage and restore their functioning;
- Rehabilitation.
When using immunosuppressive agents are considered as the reasonable doses that cause remission and prevent effective immune response with exacerbation of the disease.
The goal of treatment:
- Stable remission;
- Normal human activity after therapy.
For the treatment of vascular diseasesused:
- Cytotoxic means;
- Glucocorticoids;
- Immunoglobulin;
- Plasmapheresis.
Glucocorticoids are the most effective for today tools in the fight against all types of vascular diseases. GK indispensable for a course of treatment, and spillover effects from their actions are poorly expressed.
The drugs cytotoxic effects are divided into several groups - alkylating agents and purine funds, as well as folate antagonists. The most common medications in this group is azathioprine and cyclophosphamide.
Immunoglobulin is administered intravenously and can be used for long-term therapy, and plasmapheresis is often combined with the use of glucocorticoids.
If subjected to therapy of Wegener's granulomatosis or vasculitis cryoglobulinemias, the combination of GK and plasmapheresis, the only possible solution.
The sooner you begin therapy, the higher the likelihood of achieving stable remission, therefore, an important early diagnosis of vasculitis and the exact definition of it.
To succeed, therapy must be used in the treatment of a wide range of support second-line drugs.
This:
- Cyclosporine;
- Aminohinolinovogo means;
- Enzymatic and antiviral drugs.
Cyclosporine is necessary to suppress the inflammatory process, the remaining funds show an effect only in combination therapy, where they take the place of drugs in the second and third groups.
If in the process of treatment observed increased platelet aggregation, may be assigned concurrent aspirin. Enhances the effectiveness of aspirin dipyridamole, but not prescribed in all cases. When dealing with hemorrhagic vasculitis contributes to the restoration of microcirculation in the walls of blood vascular heparin.
Depending on the disease and condition of blood vascular physicians can register:
- Vasaprostan;
- Dapsone;
- Prostacyclin;
- Colchicine.
Vazaprostan enhances the synthesis of neurotransmitters and hormones, and Dapsone will help to achieve long-term remission in hemorrhagic form of the disease. Prostacyclin prevents the emergence of digital necrosis, and Colchicine is a tool to suppress the motility of neutrophils and reduce the severity of the disease in the period of exacerbation.
Today doctors are actively used in the treatment of immunotherapy that uses monoclonal antibodies active against endothelial membrane antigens.
In immunotherapy in the fight for a cure include the body's life force thatincreases the likelihood of sustained remission.
Ointments and creams are used for ulcers on the skin that occur when behçet's syndrome, but local treatment should be graded and should take into account the specifics of the disease.
Diet is required in the treatment of some types of vasculitis, in particular low protein content is necessary when dealing with essential purpura. Hypoatherina diet important success factor in the treatment of hemorrhagic vasculitis type.
The traditional treatment of vasculitis consists of:
- Of prednisolone therapy (3 infusions of 1000 ml.);
- The introduction of cyclophosphamide (1 infusion 1000 ml.);
- A course of plasmapheresis in combination with the introduction of immunoglobulin.
For successful treatment it is necessary the active participation in the therapeutic process therapists, rheumatologists, oculists, surgeons and nephrologists, the shares of which vary depending on stage and type of disease of the vascular.