From this article you will learn: the characteristics of vasculitis, what kind of disease it is, and how to treat it. Types of pathology, methods of treatment.

Article publication date: 04/30/2017

Article last updated: 05/29/2019

Vasculitis - what is it? This is a group of diseases accompanied by inflammation and subsequent necrosis (necrosis) of the vascular wall. This group of pathologies leads to a significant deterioration in blood circulation in the tissues surrounding the vessel. Different forms of these ailments have both characteristic and general symptoms (fever, weight loss, rash that does not disappear with pressure, joint pain). Left untreated, the primary lesion may spread and cause damage to other tissues or organs. Subsequently, the disease can lead to disability and even death.

While vasculitis is still insufficiently studied, and experts have not come to a consensus on the causes and mechanisms of inflammation, classification and tactics of therapy. Now this disease is classified as a systemic connective tissue disease, and rheumatologists are engaged in its treatment. If necessary, infectious disease specialists and dermatologists can be involved in therapy.

According to statistics, both men and women are equally often ill with vasculitis, and most often they are detected in children and the elderly. Every year the number of such patients of a rheumatologist increases, and experts believe that such an increase in the incidence is associated with the uncontrolled intake of immune stimulants and environmental degradation.

Types of vasculitis

A disease such as vasculitis is classified according to different parameters.

According to the root cause, the following two forms of the disease are distinguished:

1. Primary - damage to the vascular wall is caused by unexplained reasons, presumably it is provoked by malfunctions in the immune system.
2. Secondary - damage to the vascular wall is a reaction to infections (tuberculosis, hepatitis, syphilis), systemic lesions (collagenoses, systemic lupus erythematosus, reactive arthritis), sarcoidosis, cancerous tumors, helminthic invasions or chemicals.

According to the severity of the course, vasculitis can be:

• mild degree - they appear only as a mild rash and do not cause a deterioration in the general condition;
• moderate degree - the patient has a profuse rash, joint pain, blood in the urine, and the general condition is moderate (loss of appetite, weakness);
• severe - the patient has a profuse rash, significant disorders in organs and joints, pulmonary and intestinal bleeding appear, kidney failure develops, and the general condition is severe.

Depending on the type of inflamed vessels, the following forms of vasculitis are distinguished:

• capillary - inflamed capillary walls;
• arteriolitis - the walls of arterioles are inflamed;
• arteritis - arterial walls are inflamed;
• phlebitis - inflamed venous walls.

Depending on the location of the affected vessels, the following forms and varieties of vasculitis are distinguished:

General symptoms

Symptoms of vasculitis are extremely diverse, and the most characteristic sign of these ailments is a rash on the skin. The severity of the signs of the disease and the general condition of the patient largely depends on the form and type of vasculitis. In severe cases and if untreated, the disease can cause disability or death.

Rash

Signs of skin rashes with vasculitis can be varied, but a number of them allow you to distinguish this disease from others:

• the appearance of a rash is often associated with an infection;
• the rash appears against the background of an allergy, systemic, autoimmune or rheumatic disease;
• the rash is relatively symmetrical;
• the first elements of rashes appear precisely on the legs (usually in the area of ​​\u200b\u200bthe legs);
• elements of the rash are predisposed to hemorrhages, edema and necrosis;
• the rash is often represented by various elements that change their color, size and shape over time.

In patients with vasculitis, the following types of rashes can be detected:

1. Spots. They are red or pink elements of the rash that do not rise above the level of the skin. Caused by a rush of blood in response to inflammation.
2. Hemorrhagic purpura. Elements of rashes occur with significant damage to the vessel wall and hemorrhage. The rash may look like macules or purplish telangiectasias. The dimensions of elements with uneven contours can reach 3–10 mm. After a while, the rashes turn blue, and then acquire a yellowish tint. After pressing, the rash does not disappear.
3. Hives. Such a rash is provoked by an allergic reaction and is accompanied by burning, tingling and itching. It manifests itself in the form of pink or red bubbles with irregular contours.
4. Subcutaneous nodes. Such elements of the rash are caused by uncontrolled growth of connective tissue and epidermis. They are raised semicircular or flat nodules. Their size can vary from a few millimeters to 1–2 cm. They are painful, and over time, an area of ​​necrosis may appear in their center due to a significant violation of blood circulation. Subsequently, the skin in this place of the nodule turns black and begins to be rejected.
5. Bubbles. Violations of the permeability of the vascular walls in a certain area of ​​the bloodstream lead to the release of the liquid part of the blood under the skin. In such places, bubbles larger than 5 mm appear. They are filled with transparent contents, which may contain blood inclusions.
6. Ulcers and erosions. The subcutaneous nodes formed during vasculitis disintegrate over time, and erosions (superficial lesions) or deeper skin defects - ulcers occur in their place. When infected, they can suppurate.

Intoxication

Vasculitis is accompanied by circulatory disorders, leading to the formation of toxins, poisoning of the body and changes in metabolism. These processes cause the patient to experience the following symptoms:

• decreased exercise tolerance and weakness;
• loss of appetite and weight loss (up to 0.3-1 kg every month);
• frequent drowsiness;
• headaches (the degree of their intensity depends on the severity of the disease);
• temperature rise to 37.5-40 degrees (depending on the severity of the disease).

Nervous System Damage

Exposure to toxins and damage to the nervous tissue caused by circulatory disorders and hemorrhages in vasculitis provoke the following symptoms:

• sudden changes in the psycho-emotional state;
• seizures;
• muscle weakness, incomplete paralysis of the arms and legs,
• changes in sensitivity (more often by the type of "socks" and "gloves" - that is, in these areas of the body);
• hemorrhages in the brain, leading to the development.

visual impairment

The insufficient blood supply and nutrition of the organs of vision observed in vasculitis can cause their unilateral or bilateral damage:

• constantly progressive deterioration of vision (up to complete blindness);
• swelling and redness of the eye;
• feeling of difficulty in moving the eyeball;
• protrusion of the eye.

Respiratory damage

The presence of an inflammatory reaction and a violation of the permeability of the vascular walls in vasculitis leads to swelling and inflammation of different parts of the respiratory system. As a result, the following respiratory diseases can develop:

1. Prolonged runny nose.
2. Chronic sinusitis and sinusitis.
3. Destruction of the bony walls of the maxillary sinus or nasal septum.
4. Chronic bronchitis with asthmatic component.
5. Bronchial asthma.
6. Pleurisy.
7. Pneumonia.
8. bronchiectasis.

With ruptures of the walls of blood vessels, the patient develops broncho-pulmonary bleeding of varying intensity.

Kidney damage

Many types of vasculitis lead to malnutrition and kidney function. Initially, the patient shows signs of a decrease in their function, manifested by the following symptoms:

• lower back pain;
• fever;
• swelling;
• decrease in the volume of urine excreted;
• protein and blood in the urine.

Subsequently, the violation of blood circulation and nutrition in the renal tissues becomes more pronounced, and the tissues of these organs are affected more massively. Because of such changes, the patient develops acute and then chronic renal failure.

Joint damage

Vasculitis is accompanied by damage to the joint bag, which is caused by the penetration of fluid into it, the development of inflammation and edema. The knee joints are the first to suffer more often, and the patient has the following symptoms:

• redness, swelling and rash in the knee area;
• intense pain leading to difficulty in motor function.

A few days later, the inflammatory process passes to neighboring joints and the pain in the knees becomes weaker. Usually, such joint damage resolves itself and does not lead to irreversible consequences.

Digestive disorders

Damage to the walls of the vessels of the mesentery and intestines causes a violation of blood circulation and leads to the appearance of hemorrhages. As a result, an inflammatory reaction develops and a patient with vasculitis develops the following symptoms:

• paroxysmal and intense pain in the abdomen, aggravated half an hour after eating;
• nausea and vomiting;
• rapid watery stools (sometimes with inclusions of blood).

Massive vascular damage can cause atrophy, gradual destruction and rupture of the intestinal wall. With such large-scale lesions, the patient develops peritonitis.

Treatment

Treatment of vasculitis should be complex, and its tactics depend on the severity and type of disease. It can be done on an outpatient basis or in a rheumatology department.

Indications for hospitalization of a patient with vasculitis are as follows:

1. Moderate or severe form.
2. Debut or exacerbation of the disease.
3. Pregnancy period.
4. Childhood.
5. hemorrhagic vasculitis.

During the acute phase of the rash, patients are advised to stay in bed, which contributes to the disappearance of the rash and stabilization of blood circulation. A week after the appearance of the last elements of the rashes, the regimen is gradually expanded.

Medical therapy

The choice of certain drugs for the treatment of vasculitis can only be performed by a doctor, taking into account the patient's examination data, the severity and type of the disease. With a mild form, the drug is prescribed for 2-3 months, with a moderate form - for about 6 months, and with a severe form - up to a year. If vasculitis is recurrent, then the patient is treated in courses of 4-6 months.

The following drugs can be used to treat vasculitis:

• non-steroidal anti-inflammatory (Ortofen, Piroxicam, etc.) - eliminate inflammatory reactions, joint pain, swelling and rash;
• antiplatelet agents (Aspirin, Curantil, etc.) - thin the blood and prevent the formation of blood clots;
• anticoagulants (Heparin, etc.) - slow down blood clotting and prevent thrombosis;
• enterosorbents (Nutriklinz, Thioverol, etc.) - bind toxins and bioactive substances formed during the illness in the intestinal lumen;
• glucocorticosteroids (Prednisolone, etc.) - have an anti-inflammatory effect in severe vasculitis, suppress the production of antibodies;
• cytostatics (Azathioprine, Cyclophosphamide, etc.) - are prescribed for the ineffectiveness of glucocorticosteroids and the rapid progression of vasculitis, suppress the production of antibodies;
• antihistamines (Suprastin, Tavegil, etc.) - are prescribed only for children in the initial stages of vasculitis in the presence of drug or food allergies.

Non-drug therapy

With vasculitis, to cleanse the blood of substances that cause and aggravate the disease, the attending physician may recommend that the patient undergo various methods of gravitational blood surgery:

1. Immunosorption - venous blood is purified by passing through an apparatus with an immunosorbent.
2. Hemosorption - blood is passed through a device with a sorbent that purifies it from antibodies, immune complexes and antigens.
3. Plasmapheresis - blood passes through a special apparatus that purifies or replaces its plasma.

Hypoallergenic diet and nutrition

Vasculitis often predisposes to an allergic reaction, and to prevent such a complication, patients are advised to exclude the following foods from their diet:

• eggs;
• chocolate;
• red fruits and berries (especially strawberries and strawberries);
• citrus;
• honey, royal jelly, pollen;
• products with flavor enhancers, stabilizers, dyes and non-natural flavors (sausages, flavored cheeses, pates, crackers, chips, etc.);
• mushrooms;
• pastries from sweet dough;
• canned food;
• coffee and strong tea;
• spicy, salty and fried foods;
• alcohol;
• individually intolerant foods.

Phytotherapy, non-traditional and folk methods

Self-treatment of vasculitis is unacceptable, because taking certain medicinal herbs can provoke allergies and aggravate the course of the disease. In the absence of contraindications, a rheumatologist may recommend the following herbal remedies, non-traditional and folk methods:

• liquorice root;
• herbal teas based on calendula, horsetail, poplar buds, string, elder flowers, peppermint, yarrow, etc.;
• hirudotherapy (medical leeches).

Forecasts

The prognosis of this disease depends on its type and form, the age of the patient, the presence of complications and the timeliness of the start of therapy. The five-year survival rate of patients with severe vasculitis, the treatment of which was started immediately and with the use of glucocorticosteroids and cytostatics, is 90%. Without timely therapy, this figure is only 5% and leads to disability and death.

The following clinical cases can worsen the prognosis for vasculitis:

1. Kidney damage.
2. CNS damage.
3. Damage to the coronary vessels and aorta.
4. Damage to the digestive organs.
5. The development of vasculitis after 50 years.

These facts mean that people with such diseases need constant dispensary observation and strict adherence to all doctor's recommendations. This attitude to their health will help them avoid the development of serious complications.

Vasculitis - what is this disease? Causes, types and forms of vasculitis (hemorrhagic, allergic, systemic, skin, etc.), symptoms and diagnosis of the disease, photo

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Vasculitis- This is a group of diseases in which inflammation and necrosis of the wall of blood vessels occurs, which leads to a deterioration in blood flow in the surrounding tissues. The disease remains completely unexplored: there are disputes about the causes of vasculitis, the mechanism of inflammation, classification and treatment approaches. According to the modern classification, vasculitis refers to systemic diseases of the connective tissue. He is treated by rheumatologists.

There are no exact statistics on the incidence of vasculitis, however, doctors note that the number of people with this pathology is increasing every year. Perhaps this is due to the deterioration of the environmental situation and the uncontrolled intake of immunostimulating agents. It has been found that children and the elderly are more susceptible to the disease. Men and women get sick equally often.

Different forms of vasculitis have their own characteristic symptoms. General manifestations of the disease: fever, skin rashes that do not disappear with pressure, joint pain, weight loss. From the initial focus, vasculitis can spread to other organs and tissues, with the kidneys most often affected.

Causes of vasculitis

The causes of vasculitis are diverse - inflammation of the walls of blood vessels can be caused by various factors:

• Microorganisms:
  • streptococci;
  • staphylococci;
  • typhoid bacillus;
  • mycobacterium tuberculosis;

Helminths:

• bovine and pork tapeworm.

yeast mushrooms genus Candida.

Autoimmune diseases in which an inadequate immune response develops:

• reactive arthritis;
• systemic lupus erythematosus;
• collagenoses.

Medications to which a person is hypersensitive:

• sulfa drugs;
• anti-tuberculosis drugs;
• vitamin complexes;
• oral contraceptives.

Chemical substances:

• oil products;
• insecticides;
• household chemicals.

Hypothermia of the body - in the blood of some people, special proteins are formed - cryoglobulins, which can block the lumen of the vessel and cause vasculitis.

Hypersensitivity to tobacco components becomes the cause of one of the varieties of vasculitis - thromboangiitis obliterans.

genetic predisposition. Most patients have relatives who suffer from various forms of vasculitis or other autoimmune diseases. This indicates that disorders can be inherited.

According to the latest data, the main role in the development of vasculitis is assigned to staphylococci and streptococci. This is proved by the presence of the corresponding antigens in the blood of most patients.

Disposing factors. The development of the disease is almost always preceded by situations that reduce immunity and disrupt the normal course of immune reactions:

• age - children and the elderly are most susceptible. These categories are often marked by immaturity or age-related decline in immunity;
• diseases associated with metabolic disorders - diabetes mellitus, atherosclerosis, gout, thyroid pathology, hypertension, liver disease;
• prolonged exposure to the sun;
• excessive mental stress;
• severe injuries and operations;
• work associated with prolonged standing;
• lymphostasis - a violation of the outflow of lymph;
• tendency to allergic reactions;
• chronic infectious foci - otitis, adnexitis, sinusitis, tonsillitis.

The mechanism of the development of the disease

1. Immune complexes appear in the patient's blood, consisting of an antigen and an antibody. For an unknown reason, they are fixed on the endothelium (inner membrane) of the vessels.

2. Further, the vascular wall is infiltrated by immune cells, neutrophils. As a result of reactions, enzymes (myeloperoxidase, elastase, lysozyme, lactoferrin) and hydrogen peroxide are released through the neutrophil wall. These aggressive substances destroy the walls of blood vessels and cause inflammation.
3. The vascular wall becomes the target of an attack by the immune system - specific antibodies begin to be produced that target the vascular endothelium.
4. Antiendothelial antibodies attack the vascular wall, making it more permeable and fragile.
5. Immune inflammation is often accompanied by the formation of blood clots that block the lumen of blood vessels.
6. The destruction of the vascular wall leads to its rupture and hemorrhage into the surrounding tissues.
7. Circulatory disorders lead to the fact that the surrounding tissues receive insufficient oxygen and nutrients. This causes cell death and necrosis of individual tissue areas.

Types and forms of vasculitis. Vasculitis classification

The generally accepted classification of vasculitis has not yet been developed. According to various sources, there are 60-80 forms of the disease. They are classified according to various criteria.

Classification of vasculitis by severity

Form of vasculitis	signs
mild vasculitis	Slight rash, the general condition of the patient is not changed.
Moderate vasculitis	Severe rash, joint pain, erythrocytes in the urine, the general condition of patients is moderate - weakness, loss of appetite.
severe vasculitis	Numerous rashes, significant changes in the joints and internal organs, intestinal and pulmonary bleeding, acute renal failure. The general condition of the patients is severe.

Classification according to the underlying cause of the disease

Form of vasculitis	signs
Primary vasculitis	Inflammation and necrosis of the vessel walls is the first sign of the disease, and pathological changes around the vessels are secondary. The causes of extensive vascular lesions often remain unclear. They are associated with a violation of the immune system.
Secondary vasculitis	Vascular damage as a reaction to: infectious diseases - hepatitis, syphilis, tuberculosis; systemic diseases - reactive arthritis, systemic lupus erythematosus, collagenoses; malignant tumors, sarcoidosis; chemical substances.

Classification according to the size of the affected vessels

Classification according to the type of vessels affected

Classification according to the localization of the affected vessels

Form of vasculitis	Types of vasculitis
Systemic- inflammation spreads to several parts of the body.	Giant cell temporal arteritis; Wegener's granulomatosis; Nodular periarteritis; Behçet's syndrome; Thromboangiitis obliterans.
Vasculitis of individual organs (segmental) - inflammation is localized in individual organs or departments of the vascular system.	Skin- periarteritis nodosa, cutaneous leukocyte angiitis, cutaneous arteritis; joints- hemorrhagic vasculitis; hearts– isolated aortitis; Brain- Primary CNS angiitis.

The most common types of vasculitis and their symptoms

Damage to large vessels

1. Giant cell (temporal) arteritis

Giant cell (temporal) arteritis - inflammation of large and medium-sized arteries. On the inner wall of the vessel, granulomas are formed - clusters of lymphocytes and giant multinucleated cells, which look like dense nodules. Separate segments of the temporal, ophthalmic and vertebral arteries are affected, less often the arteries of the liver and intestines. Blood clots form at the affected sites, which can cause a stroke. It is also possible to damage the aorta, which can lead to ruptures. The disease develops in elderly people aged 50-90 years with well-preserved immunity. The number of sick men and women is approximately the same.

Symptoms

• The temperature rises to 37.5-40 degrees.
• Signs of general intoxication - weakness, drowsiness, sweating, weight loss.
• Headache . Pain in areas corresponding to the affected arteries (usually in the temples).
• The skin over the affected vessels is reddened. Pressure in this area causes pain. Unevenly thickened arteries are palpated under the skin.
• Sharp pain in the chewing muscles and tongue when chewing.
• Decreased or absent pulse in distant parts of the damaged artery.
• Violation or partial loss of vision with damage to the ophthalmic arteries. Visual disturbances can be temporary or permanent.

Damage to medium-sized vessels

1. Nodular periarteritis

Periarteritis nodosa is an inflammation of the vascular wall of small and medium-sized arteries. Numerous nodular thickenings and microaneurysms (protrusions of the wall resulting from its overstretching) are formed in them, which disrupt the blood flow. In 75% of patients, the internal organs are affected, in 25% the skin. It is more common in men 30-60 years old. The reason for the development has not been established.

Symptoms

2. Kawasaki disease

Kawasaki disease - mainly affects medium-sized arteries. More often than others, the coronary arteries of the heart, as well as the mucous membranes of the nasopharynx, suffer. Thickenings form on the inner wall of the vessel - the lumen narrows and can become clogged with a thrombus. The wall of the vessel stratifies, leading to the formation of an aneurysm. It develops 1-3 weeks after suffering streptococcal or staphylococcal infections. It occurs in children 1-5 years old. Boys get sick more often than girls. In Japanese, Kawasaki disease is 10 to 30 times more common than in European countries. The prognosis in most cases is favorable, recovery occurs in 6-10 weeks.

Symptoms

• Acute fever. The fever lasts 12-45 days.
• Redness of the conjunctiva.
• Dryness and redness of the lips.
• Redness of the oral mucosa.
• Enlarged cervical lymph nodes unilateral or bilateral.
• Severe redness of the fingers and toes associated with dilated capillaries.
• Dense swelling of the feet and hands.
• Rash - small red dot elements (resembling a rash with scarlet fever) are located on the trunk, limbs and in the inguinal folds.
• "Raspberry" language. This symptom appears in the second week after the onset of the fever.
• Peeling of fingers and toes. The skin leaves in plates 2-3 weeks after the onset of the disease.

Damage to small vessels

1. Wegener's granulomatosis

Wegener's granulomatosis is a severe form of vasculitis associated with impaired immunity. Manifested by a runny nose, sore throat and cough. Small arteries, veins and capillaries are affected. In connection with the accelerated division of cells, numerous granules are formed on their walls, and over time, necrosis of the inner choroid occurs. In 90% of patients, the ENT organs and lungs are affected. Men get sick 2 times more often than women. The average age of patients is about 40 years.

Symptoms
Symptoms increase gradually and without treatment, the patient's condition worsens.

2. Hemorrhagic vasculitis

Hemorrhagic vasculitis or Henoch-Schonlein disease is an inflammation of the skin vessels, which is further complicated by damage to the joints, gastrointestinal tract and kidneys. Predominantly the smallest veins (venules) and capillaries suffer. Hemorrhagic vasculitis develops 1-3 weeks after an infectious disease. The main group of patients - children 4-8 years old, mostly boys.

Symptoms

• Acute onset with fever and severe intoxication. In adults, the onset is usually blurred.
• Papular-hemorrhagic rash is characteristic of the skin form. Red elements rising above the skin. When pressed, the rash does not disappear. Over time, its color changes, darkens. When the rash disappears, small scars may remain.
• The nature of the rash is polymorphic. On the body of the patient can be simultaneously detected:
  • red spots;
  • papules - stripless small nodules;
  • vesicles filled with bloody contents;
  • pustules with purulent contents;
  • necrosis - areas of necrosis;
  • telangiectasias - dilated vessels under the skin;
  • blisters - dense formations without a cavity inside;
  • ulceration - deep defects of the epithelium.
• Symmetrical location of the rash. Mostly it is localized on both legs and buttocks.
• Wavy appearance of eruptions. New rashes appear 1 time in 6-8 days. The first waves of the rash are always the most abundant.
• Damage to the joints is characteristic of the articular form. Joint pain appears simultaneously with the rash or a few days later. The knee and ankle joints are predominantly affected. Pain, swelling and redness appear. These changes are reversible and disappear after a few days.
• Gastrointestinal phenomena. Occur in the abdominal form of hemorrhagic vasculitis. When these symptoms appear, a surgeon's observation is required:
  • cramping pain in the abdomen;
  • nausea;
  • vomit;
• Kidney damage develops in patients with renal vasculitis. Manifestations range from mild increases in protein and red blood cells in the urine to symptoms of acute glomerulonephritis:
  • oliguria - a decrease in the daily volume of urine to 500 ml;
  • pale skin;
  • dyspnea;
  • pain in the lumbar region and headache;
  • edema, especially on the face. The amount of "extra" water in the body can reach 20 liters;
  • increase in blood pressure up to 180/120 mm Hg.
• Necrotic purpura is characteristic of the fulminant form of the disease. Foci of necrosis appear on the skin, exuding an unpleasant odor, ulcerations, crusts of gore. With such a course of the disease, the patient's condition is severe and he needs emergency help.

3. Churg-Strauss Syndrome

Churg-Strauss syndrome is an inflammatory-allergic disease with the formation of necrotizing inflammatory granulomas in small and medium-sized vessels. The disease affects the respiratory, central and peripheral nervous system, skin and joints. The age of patients is 15-70 years, women get sick more often than men.

In its development, Churg-Strauss vasculitis goes through several stages:

• lesions of the nasal mucosa - lasts several years;
• lung damage - lasts 2-3 years;
• systemic vasculitis with damage to many organs (nervous system, skin, joints) has a chronic course.

Symptoms

• Allergic rhinitis - nasal congestion is the first sign of the disease.
• The growth of polyps in the nasal passages.
• Lung damage is associated with eosinophilic infiltration - the penetration of eosinophils into the mucous membrane of the respiratory tract. There are severe attacks of coughing, suffocation, hemoptysis, shortness of breath, chest pain with deep breathing. Patients experience:
  • prolonged bronchitis with an asthmatic component;
  • bronchial asthma is a chronic disease manifested by narrowing of the airways and attacks of suffocation;
  • bronchiectasis - local expansion of the lumen of the bronchi;
  • eosinophilic pneumonia - inflammation of the lungscaused by the accumulation of eosinophils in the lung alveoli;
  • pleurisy - inflammation of the pleura (the serous membrane that covers the lungs).
• Damage to the heart is associated with the destruction of the coronary vessels that feed it. It is manifested by pain in the region of the heart and a violation of the heart rhythm (tachycardia or bradycardia). Patients develop:
  • myocarditis - inflammation of the heart muscle;
  • coronaritis - inflammation of the coronary vessels of the heart;
  • constrictive pericarditis - inflammation of the outer connective tissue membrane of the heart, in which fluid accumulates in its cavity, squeezing the chambers of the heart;
  • damage to the mitral and tricuspid valves;
  • myocardial infarction - necrosis (death) of a portion of the myocardium that has arisen due to impaired blood supply.
• Damage to the nervous system is called "brain vasculitis". Develops:
  • peripheral neuropathy - damage to the peripheral nerves: the optic nerve, the roots of the spinal nerves (sciatica);
  • hemorrhagic stroke - cerebral hemorrhagecaused by rupture of the vessel;
  • epileptic seizures - spontaneous seizures of convulsions;
  • emotional disorders.
• Rash on the skin of the lower extremities
  • hemorrhagic purpura - bleeding into the skin. Painful small red-purple spots with irregular edges;
  • erythema - redness of the skin;
  • urticaria - small blisters that rise above the skin;
  • subcutaneous nodules are hard, smooth formations.
• Joint damage. Arises migratory arthritisaffecting successively several joints. The ankle, knee, wrist and elbow joints are most commonly affected. Churg-Strauss syndrome is characterized by symmetrical joint damage.
• Kidney damage - damage to individual renal glomeruli. It occurs rarely, proceeds unexpressed. Pathology is indicated only by deviations in urinalysis.

Symptoms of vasculitis

The most common symptom of vasculitis is a rash. Skin rashes in vasculitis are very diverse, but it is possible to distinguish A few signs that distinguish vasculitis from other diseases:

• the first elements appear on the lower extremities, mainly on the legs;
• symmetrical location of the rash;
• the tendency of rashes to edema, necrosis and hemorrhage;
• evolution and polymorphism of elements - over time, the rash changes shape or color;
• connection of the rash with a previous infection;
• the appearance of a rash on the background of allergic, autoimmune, rheumatic or systemic diseases.

Vasculitis - symptoms with a photo

Symptom	Origin mechanism	Manifestations
General deterioration
Intoxication	Poisoning the body with toxins that are formed when blood circulation is disturbed.	Weakness, loss of appetite, drowsiness, loss of strength.
Headache	Effects of toxins on the central nervous system.	The intensity of pain depends on the number and location of damaged vessels. Intense pain occurs with systemic vasculitis and damage to the vessels of the brain.
weight loss	The result of metabolic disorders and loss of appetite.	Causeless weight loss of 0.3-1 kg per month.
Temperature rise	The response of the body to the presence of toxins that appear when blood circulation deteriorates.	In mild forms, the temperature rises slightly - up to 37.5 degrees, and in severe forms - up to 40. Fluctuations during the day are characteristic.
Rash on the skin
Spots	Areas of skin redness are associated with local expansion of capillaries and intense blood flow.	Red or bright pink elements that do not rise above the level of the skin.
Hemorrhagic purpura	Damage to the vascular wall leads to its rupture. Subcutaneous hemorrhage occurs. Irritation of nerve endings and aseptic (without the participation of microorganisms) inflammation leads to painful sensations in the area of ​​​​rashes.	Hemorrhages can be in the form of spider veins or spots, ranging in size from a match head to a lentil grain. Crimson spots with a diameter of 3-10 mm, with irregular edges. Over time, the rash turns blue, then becomes yellowish due to the destruction of blood cells. When pressed, the rash does not disappear.
Hives	It is a manifestation of an allergic reaction. Histamine increases vascular permeability. The layers of the skin are soaked with fluid, which leads to the formation of blisters. Irritation of the nerve endings of the skin causes itching and burning.	Blisters are pink or red elements without a cavity. These elements are not correct.
Subcutaneous nodules and nodes of different sizes	They are formed during the infiltration of a limited area of ​​​​the skin by eosinophils, which causes the growth of the epidermis and connective tissue. Violation of blood circulation leads to necrosis in the center of the nodes.	Dense, painful, flat or semicircular, hard, stripless masses that rise above the level of the skin. The size is from a few millimeters to 1-2 cm. Necrosis can develop in the center of the nodules - the tissue turns black and is rejected.
bubbles	The increased permeability of the vessel walls in a limited area leads to the release of fluid under the skin and the formation of blisters.	Formations larger than 5 mm, filled with liquid content. It can be transparent or mixed with blood.
Erosions and ulcers	Defects of the epidermis and dermis that occur when tissues are malnourished and nodules disintegrate.	Superficial (erosion) or deep (ulcer) skin defects.
Damage to the nervous system
mood swings	Emotional disorders cause toxins. They affect the cerebral cortex and the limbic system, which is responsible for managing emotions.	Sudden mood swings, causeless tantrums, depression.
Seizures	Intracranial hemorrhage or the formation of foci of synchronous impulses in the brain cause certain muscle groups to contract.	Uncontrolled contractions and relaxation of the muscles of the whole body or individual groups.
Nerve fiber damage	Neuropathy is damage to nerve fibers associated with a violation of their blood circulation. This leads to a violation of the sensitivity and motor function of the areas for which the damaged nerves are responsible.	Muscle weakness, often asymmetrical. Paresis (incomplete paralysis) of the muscles of the limbs. Increase or decrease in sensitivity in the type of "gloves" and "socks".
Hemorrhagic stroke	Hemorrhage in the brain tissue with the destruction of the vessel wall. In this case, small and large hematomas are formed that disrupt the functioning of the brain.	Panic and disturbance of consciousness. Headache, shortness of breath. Increased or slow heart rate. Dilated pupil, possible divergence of the eyeballs. Violations of muscle tone - paresis of the limbs, asymmetrical tone of the muscles of the face.
Lung damage
Chronic bronchitis with asthmatic component	The penetration of eosinophils into the bronchial mucosa leads to its swelling and inflammation.	Prolonged paroxysmal cough with a small amount of sputum. The asthmatic component is manifested by difficult and noisy exhalation. When a bacterial infection is attached, the temperature rises and purulent sputum is released when coughing.
Bronchial asthma	Non-infectious inflammation of the bronchi in vasculitis makes them very sensitive to various allergens. Spasm of the bronchi severely limits the access of air to the lungs.	Attacks of suffocation, during which the inhalation becomes short, and the exhalation is difficult, long and noisy. Loud whistling rales are heard from the side.
Eosinophilic pneumonia	Non-infectious inflammation of the lungs is associated with chronic eosinophil infiltration.	Fever, weakness, shortness of breath, night sweats. Cough with scanty clear expectoration.
Pleurisy	Inflammation of the pleura is caused by impaired blood circulation. Accompanied by the accumulation of fluid between the layers of the pleura, which leads to compression of the lung.	Slight fever, pain when taking a deep breath. Shortness of breath and shallow breathing.
Bronchial or pulmonary bleeding	Associated with rupture of the vessel wall or destruction of the infiltrate.	Bleeding may be minor and show up as streaks of blood in the sputum. When a large vessel ruptures, a significant amount of blood is released from the respiratory tract.
Bronchiectasis	Expansion and deformation of the bronchi with prolonged eosinophilic infiltration and circulatory disorders	When a blood vessel is damaged, pulmonary bleeding develops. During exacerbations, a cough occurs with a large amount of purulent sputum, which is discharged after a night's sleep. Cyanosis (blue) of the extremities, shortness of breath, general malaise, fever.
visual impairment
Optic nerve damage	Malnutrition of the optic nerve leads to its atrophy.	A progressive decrease in vision that can lead to total blindness. Visual impairment can be unilateral or bilateral.
Protrusion of the eyeball - exophthalmos	Granulomatosis of the orbit of the eye. At the initial stage, the growth of cells capable of phagocytosis occurs. In the future, granulomas are replaced by connective tissue that pushes the eye outward and downward.	Swelling and redness of the tissues of the eye. Difficulty moving the eyeball.
Respiratory system lesions
Prolonged rhinitis, sinusitis and sinusitis	An increase in vascular permeability leads to mucosal edema and inflammation, which gives rise to allergic rhinitis.	Prolonged runny nose. Mucous discharge mixed with blood. Dry scabs in the nose. Olfactory disorders. Recurrent nosebleeds. Edema in the back of the nose and one half of the face.
Destruction of the nasal septum and walls of the maxillary sinus	Malnutrition and proliferation of granulation tissue leads to the destruction of cartilage and bone.	Falling back of the nose Difficulty in nasal breathing, purulent-mucous discharge mixed with blood.
Kidney damage
Decreased kidney function	The deterioration of the kidneys is associated with disruption of the vessels that provide nutrition to the glomerular apparatus.	Pain in the lumbar region, swelling, fever, dry mouth. Decreased volume of urine. With a slight lesion, the appearance of protein and red blood cells is possible. With massive damage to the kidney tissue, the urine may become cloudy or acquire a reddish tint due to the admixture of blood.
Acute and chronic renal failure	Massive damage to the kidney tissue leads to the fact that they lose their ability to perform their function.	General weakness, swelling, itching, high blood pressure, sleep disturbances. An increase and then a decrease in the amount of urine produced.
Joint damage
Arthritis	Damage to the vessels of the articular capsule leads to the fact that additional fluid is released into the joint cavity. It causes swelling of the joint, which is accompanied by pain.	The knee joints are usually the first to be affected. They turn red and swell, swelling spreads to the surrounding areas. A rash may appear on the skin over the joints. No joint deformity was observed. The pain is quite strong and can deprive a person of the ability to move. After a few days, the inflammation spreads to neighboring joints, while the pain in the primary focus decreases. In most cases, the changes are reversible. They go away on their own without treatment.
Gastrointestinal lesion
Abdominal pain	Damage to the vessels of the intestine and mesentery leads to impaired blood circulation. Multiple hemorrhages in the intestinal wall and peritoneum provoke edema and non-microbial inflammation. At the same time, sensitive nerve endings are irritated and acute pain occurs, which can mimic an attack of appendicitis.	Severe paroxysmal pain in the abdomen, which is in the nature of colic. Often located in the umbilical region. Increases 20-30 minutes after eating.
Digestive disorders	Damage to the intestinal vessels disrupts its function. May lead to atrophy and destruction of the intestinal wall and intestinal perforation.	Patients have nausea and vomiting. Frequent watery stools in small portions, sometimes with an admixture of blood.

Diagnosis of vasculitis

1. Examination by a doctor

The doctor conducts an examination, studies the presence and nature of the rash. During a conversation with a patient, the doctor finds out:

• how long ago the first symptoms of the disease appeared;
• whether infections preceded the disease;
• whether there is a tendency to allergies;
• whether individual sensitivity to drugs was observed;
• whether there are chronic diseases that are foci of chronic infection;
• whether there are complaints of a runny nose, cough, pain in the abdomen, joints or lower back.

2. Additional examination methods help to correctly diagnose, determine the form of vasculitis and the severity of the lesion.

Type of study	The essence of the study	Signs of vasculitis detected in this study
Clinical blood test	A study that allows you to evaluate various indicators of peripheral blood, which indicate changes in the body - the number and ratio of blood elements, the erythrocyte sedimentation rate.	Elevated ESR is a common but not specific sign of vasculitis. Shift of the leukocyte formula to the left.
Coagulogram	Determination of blood clotting.	The patient has signs of intravascular activation of the blood coagulation process. An increase in the level of fibrinogen (a protein that ensures blood clotting) over 4 g / l. Inhibition of fibrinolysis - the process of dissolution of blood clots slows down. Paracoagulation products are detected. This means that bacterial components are present in the blood, causing increased blood clotting. Increased spontaneous platelet aggregation - red blood cells change in such a way that the process of thrombus formation is enhanced. D dimers over 500 ng/ml are found. These are large fragments of fibrin breakdown, indicating the active formation of blood clots in vessels damaged by vasculitis.
Analysis for C-reactive protein	The detection of C-reactive protein in the blood indicates an inflammatory or autoimmune process in the body.	Detection of CRP over 80-100 mg/l indicates the presence of the disease. The higher the score, the more severe the degree of vasculitis. However, this indicator also increases significantly in the acute period of bacterial infections, therefore it is nonspecific.
Immunological studies
Determination of the level of immunoglobulin in the blood	The study of venous blood serum for the level of immunoglobulins, which indicate a violation of the immune system. Exceeding the norm indicates excessive activity of the immune system.	IgA over 2.5 g / l - indicates an acute course of vasculitis. IgM over 3 g / l - a mixed form with kidney damage. IgE over 100 IU / l - wavy course of vasculitis. IgG over 16 g / l - a predominant lesion of the skin and joints.
Circulating immune complexes (CIC) in the blood	Determination in blood serum of complexes consisting of antibodies, antigen and complement components. The study allows you to assess the degree of occurrence of autoimmune diseases.	Identification of the CEC over 75 k.usl. U/l confirms the presence of vasculitis.
Analysis for antibodies to the cytoplasm of neutrophils ANCA	Determination of these antibodies in blood serum by indirect immunofluorescence.	The detection of these antibodies indicates an immune attack on immune cells - neutrophils, which is typical for systemic vasculitis.
Urinalysis
Clinical analysis of urine	Study of the physicochemical properties of urine.	Indicates kidney damage erythrocytes in the urine more than 3 in the field of view. elevated protein level over 0.033 g/l. cylinders in the renal form of vasculitis - normally they should not be.
Other types of research
Angiography (examination of blood vessels)	X-ray examination of blood vessels after the introduction of contrast agents into the blood.	In damaged vessels, segmental narrowing, expansion, or complete blockage of the vessel by a thrombus is detected. With the defeat of small-caliber capillaries, angiography is uninformative.
Chest x-ray	X-ray examination, which allows to evaluate changes in the organs of the chest.	With lung involvement, there may be Signs of inflammation of the bronchi and lung tissue; Large or small infiltrates; Cavities in lung tissue; Accumulation of fluid between the layers of the pleura, squeezing the tissue of the lung.
Biopsy (for abdominal vasculitis)	Taking a small piece of tissue from a damaged area of ​​the intestine.	With damage to the digestive tract, the following are detected: Infiltrates consisting of granulocytes and IgA deposits; immune complexes in tissues.
MRI	Study of internal organs using the phenomenon of nuclear magnetic resonance.

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Inflammation of blood vessels.

Vasculitis is a syndrome rather than a disease, a general name for a group of diseases characterized by inflammation and destruction of the walls of blood vessels. It occurs in a number of autoimmune diseases of the connective tissue: rheumatoid arthritis, systemic lupus erythematosus, etc. Vasculitis can also occur in isolation, without damage to the connective tissue.

Usually, the disease affects several tissues or organs: the narrowing of the damaged vessels disrupts the blood supply to the organs, causing the death of the tissues supplied by them. The disease can occur in any organ.

Depending on the occurrence, vasculitis is divided into two types: primary and secondary. Primary vasculitis occurs independently and is not accompanied by other diseases. Secondary vasculitis are concomitant diseases of other pathologies.

Primary vasculitis

Primary vasculitis is primarily the responsibility of rheumatologists, although the diagnosis and treatment of these diseases is impossible without the participation of doctors of other specialties: otorhinolaryngologists, ophthalmologists, neuropathologists, dermatologists, etc. Inflammation of the wall of blood vessels is an integral feature of these diseases, which is found in all patients without exception .

Primary systemic vasculitis includes:

• Nonspecific aortoarteritis (synonyms: Takayasu's disease, aortic arch syndrome);
• Giant cell arteritis (synonyms: "temporal arteritis", "senile arteritis", "Horton's disease");
• Nodular polyarteritis;
• Kawasaki disease;
• Wegener's granulomatosis;
• Microscopic polyangiitis;
• Eosinophilic angiitis and granulomatosis (synonym: "Churg-Strauss syndrome");
• cryoglobulinemic vasculitis;
• Purpura Shenlein - Henoch (synonym: "hemorrhagic vasculitis").

With all of these diseases, inflammation occurs in the wall of the vessels, however, the caliber of the affected blood vessels in different forms of vasculitis is not the same and varies from large arteries (1.0 cm in diameter or more) to the smallest arterioles, capillaries and venules, visible only under a microscope. The type of inflammation also varies. All this explains the extremely pronounced variety of clinical manifestations of primary systemic vasculitis and their dissimilarity to each other.

Secondary vasculitis

Secondary vasculitis develops as an element of another disease and can be considered either as an optional manifestation of it, or as a complication. An example is many infectious diseases: scarlet fever, typhus, meningitis, sepsis, as well as skin diseases such as psoriasis, etc.

Sometimes vasculitis can be one of the manifestations of a malignant tumor of a particular organ; in this case, the vasculitis will also be secondary, because after successful surgical, radiation or chemotherapy treatment of the tumor, the accompanying vasculitis, as a rule, disappears without any special treatment.

Vasculitis has a large number of subspecies and classifications, they differ in severity, localization and etiology. A widespread or generalized lesion of the blood vessels is called systemic vasculitis. Some vasculitis affect only the skin without causing serious harm to other organs; others can cause irreparable harm to vital organs and, without proper treatment, lead to death.

The process can develop in any blood vessel. Diseases such as Henoch-Schonlein syndrome, erythema nodosum, periarteritis nodosa, giant cell arteritis, and Takayasu's arteritis are characterized by vasculitis confined to one or more blood vessels: veins, large arteries, small arteries, or capillaries, or any specific vessel(s) such as the vessels of the head, legs, or kidneys.

Causes of vasculitis

Vasculitis is an autoimmune disease and first of all it is necessary to normalize the immune response. Vasculitis is a self-perpetuating autoimmune process in the vessels, which is caused by the following main causes:

1. infections: streptococci, staphylococci, salmonella, mycobacterium tuberculosis, hepatitis B and viruses, cytomegalovirus (one of the most insidious viruses of the herpes family), parvoviruses, etc .;
2. allergies - drug, serum, post-vaccination vasculitis;
3. with connective tissue diseases, injuries, burns, exposure to ionizing radiation.

The source of infection or the cause of an auto-aggressive immune response, like all other causes, is usually located not at all in the vessels, but elsewhere. Without solving these problems, the growth of vasculitis cannot be stopped. And problems with digestion, metabolism, as well as smoking, alcohol and chronic stress only worsen the situation.

Therefore, vasculitis is not a separate vascular disease, but an SOS signal for your entire body.

Not fully understood, for example, the role of hereditary (genetic) predisposition to the development of systemic vasculitis: in several cases, the occurrence of vasculitis in members of the same family was noted; some genes have been identified that are more common among patients with systemic vasculitis than among other individuals.

It has been shown that if it is necessary to transplant a kidney to a patient with systemic vasculitis that caused severe kidney damage, it is undesirable to use a donor organ obtained from close relatives, since genetic relationship increases the risk of recurrence of vasculitis in the transplanted kidney. However, in the vast majority of cases, vasculitis is not inherited from parents to children, and the risk of developing these diseases in offspring is minimal.

Risk factors that can cause the development of vasculitis include drug abuse, uncontrolled administration of vaccines and sera, excessive tanning and sun exposure, prolonged hypothermia. Sometimes the role of a “trigger” is played by physical trauma, psycho-emotional overstrain or alcohol consumption (sometimes even small doses of alcohol suddenly turn out to be able to provoke the development of the disease).

Symptoms of vasculitis

The symptomatic picture varies depending on the localization of vasculitis and concomitant disease.

When vasculitis affects the skin, a rash appears. In case of damage to the nerves, the sensitivity of a person is disturbed, from hypersensitivity to its complete loss. An interruption in the blood supply to the brain causes a stroke. Renal failure may develop due to renal vasculitis.

One of the most dangerous complications of vasculitis are heart attack and stroke, which most often has the most serious consequences for life.

Common symptoms of vasculitis may be lack of appetite, fatigue, weakness, fever, pallor. A constant subfebrile temperature is characteristic, which does not decrease with the use of antibiotics. Body temperature can decrease on its own or with the appointment of glucocorticoids. Weight loss in some variants of vasculitis is a classic sign, and a significant decrease in body weight in a short period of time is not only diagnostic, but also evidence of disease activity.

The manifestations of vasculitis are nonspecific. These include fever, general weakness, loss of appetite and body weight, skin rashes, hemorrhages, joint pain, swelling, swollen lymph nodes. In its course, vasculitis can be disguised as an infection, autoimmune diseases, neuritis, tumor processes, which makes it difficult to diagnose.

Nodular vasculitis is characterized by muscle pain, weight loss, abdominal pain, nausea and vomiting, mental disorders.

Wegener's granulomatosis affects the paranasal sinuses; in patients, purulent and bloody discharge comes out of the nose, the nasal mucosa becomes covered with sores, a cough (sometimes with blood) may appear, shortness of breath, chest pain, and kidney failure may develop. Giant cell arteritis is manifested by fever, weakness, weight loss, severe headaches and swelling in the temples. Symptoms of nonspecific aortoarteritis are pain and weakness in the arms and legs, blurred vision, fainting.

Behçet's syndrome is accompanied by recurring stomatitis, ulcers on the genitals, inflammation of the eyes.

When systemic vasculitis is accompanied by arthritis, the onset is usually acute or subacute. Initially, there are general phenomena of inflammation, and after a few weeks or months, a period of generalization of the disease begins.

Joint damage in systemic vasculitis manifests itself:

• joint pain without visible changes in the joints;
• transient arthritis of large joints with a benign course and reverse development without residual changes;
• arthritis with symmetrical damage to the small joints of the hands and often a long or chronic course, but without deformity of the joints.

The main signs of the progression of the disease, in which you need to immediately sound the alarm:

• the appearance of pain in the heart;
• intestinal bleeding;
• disorders of cerebral circulation;
• blood in the urine.

Kidney damage is one of the most frequent and prognostically unfavorable signs, it occurs in 20-40% of patients, depending on the form of vasculitis. Clinical symptoms of kidney damage appear at the height of the disease and already indicate pronounced changes. Various manifestations of the disease from the gastrointestinal tract, respiratory system and heart are also possible.

You should consult a rheumatologist if you have signs of an inflammatory process, such as: fever, general weakness, weight loss, not associated with a change in diet. Depending on the localization of the process in the arterial bloodstream, visual disturbances, muscle pain, and blood in the urine may occur.

Diagnosis of vasculitis

There are many syndromes in which inflammation occurs in the walls of arteries of one caliber or another. In addition, the affected area gives its symptoms.

All this complicates the diagnosis of systemic vasculitis. Diagnosis (and even more so treatment) of systemic vasculitis in most cases is difficult to implement in non-specialized medical institutions. And the attempts of patients to self-diagnose vasculitis and self-medicate are completely unacceptable and in no way justified.

As a rule, diagnostics is carried out in specialized centers on the basis of numerous microscopic, immunological, chemical and instrumental research methods.

Diagnostic measures include complete blood and urine tests, vascular examination (angiography), X-ray examination methods, tomography, and biopsy.

The diagnosis is made on the basis of the whole complex of clinical signs, features of the development of the disease, data from many laboratory and instrumental studies; at the same time, the scope of the examination (the list of necessary diagnostic methods) is always determined individually for each patient.

Vasculitis treatment

Now the diagnosis of vasculitis is more common than before.

Reception of immunosuppressive drugs may continue for several years to achieve a stable remission. At the second stage, the work of organs affected by systemic vasculitis is restored.

Therapy is prescribed based on a specific diagnosis, the cause of vasculitis. Anticoagulants, antihistamines, corticosteroids, vitamin preparations, immunosuppressors, membrane stabilizers are often used, cytostatics, plasmapheresis are possible.

The most dangerous is systemic vasculitis: its treatment is based on the intake of cytotoxic drugs, the administration of immunoglobulins, and plasmapheresis (blood purification in Wegener's syndrome). Also, the treatment of hemorrhagic vasculitis requires taking drugs that reduce blood clotting and the permeability of the walls of blood vessels. Before prescribing a diet for vasculitis, sensitizing factors (causing immune system reactions) are determined.

It must be remembered that vasculitis is always a signal of serious malfunctions in the functioning of the whole organism. Vasculitis should never be ignored. This disease, if left untreated, or treated incorrectly, always progresses, eventually leading to permanent disability or even premature death from heart failure. Therefore, for the treatment of this disease, it is very important to make the correct diagnosis in time, prescribe the correct drug treatment that does not cause allergic reactions and side effects. Thanks to high-quality adequate treatment, the life expectancy of patients is significantly increased.

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-treatment are unacceptable!

Vasculitis (angiitis, arteritis ) - the general name for a group of diseases associated with inflammation and destruction of the walls of blood vessels. Vascular inflammation can occur in any organ.

The disease of vasculitis leads to the fact that the vessels cease to perform their function correctly (blood supply to tissues and excretion of metabolic products), therefore, organs adjacent to them are affected.

Vasculitis has different classifications, may differ in localization, etiology and severity of the clinical picture. With some vasculitis, only the skin is affected, while in others, vital organs are affected.

Left untreated, vasculitis can lead to serious complications. Intestinal and pulmonary bleeding, thrombosis, kidney failure, liver failure, heart attack - this is not a complete list of the dangerous consequences of the disease. Vasculitis can lead the patient to disability and even death.

Types and classification of vasculitis

Vasculitis is one of the most serious diseases. The inflammatory process can cover both small vessels of the circulatory system (capillaries, arterioles and venules) and large ones (aorta and its large branches). Affected blood vessels can be located shallow under the skin, in the internal organs themselves and in any cavities.

Depending on the cause of the disease, 2 types of systemic vasculitis are distinguished:

• primary vasculitis (it stands out as an independent disease, in which the vessels themselves become inflamed);
• secondary vasculitis (appears as a result of other diseases or is the body's reaction to the appearance of an infection).

According to the generally accepted classification, primary vasculitis can be divided into three groups, depending on the size of the inflamed vessels:

• inflammation of small vessels (hemorrhagic vasculitis (Schonlein-Genoch purpura), Wegener's granulomatosis (vasculitis), microscopic polyangiitis, cryoglobulinemic vasculitis, Charge-Strauss syndrome);
• inflammation of the middle vessels c (periarteritis nodosa, Kawasaki disease);
• inflammation of large vessels (giant cell arteritis (or temporal arteritis, Horton's disease), Takayasu's disease);

Isolated "skin vasculitis" is also isolated, which can be a manifestation of the following diseases:

• (hypersensitive allergic vasculitis, hemorrhagic vasculitis of Shenlein-Genoch;
• erythema nodosum, vasculitis nodosum, periarteritis nodosa).

Also, vasculitis can affect various human organs:

vasculitis of the brain, vasculitis of the lungs, vasculitis of the lower extremities, vasculitis of the eye. Eyes with vasculitis can be very affected (inflammation of the arteries of the retina can lead to hemorrhages and partial loss of vision).

Usually, people who first encountered this disease are interested in whether vasculitis is contagious. Primary vasculitis is not contagious and not dangerous to others, however, secondary (infectious) vasculitis, which appeared against the background of infectious diseases, such as meningitis, can pose an epidemic danger.

Vasculitis during pregnancy can not only provoke a delay in fetal development, but also lead to miscarriage.

Symptoms and signs of vasculitis

The symptoms of vasculitis vary. They depend on the nature of the lesion, the type of vasculitis, the localization of the inflammatory process, and also on the severity of the underlying disease.

Despite the variety of options, many patients have some of the same symptoms: fever, hemorrhagic rash on the skin, weakness, exhaustion, joint pain and muscle weakness, lack of appetite, weight loss, numbness of certain parts of the body.

Thromboangiitis obliterans (or Buerger's disease) is associated primarily with damage to the blood vessels of the extremities, manifested by pain in the legs and the appearance of large ulcers on the skin (cutaneous vasculitis on the legs).

Kawasaki disease affects mainly children under five years of age and has typical signs of vasculitis (skin redness, fever, possibly eye inflammation).

Nodular periarteritis mainly affects the middle blood vessels in various parts of the body, including the kidneys, intestines, heart, nervous and muscular system, and skin. The skin is pale, the rash with this type of vasculitis has a purple color.

Microscopic polyangiitis affects mainly small vessels on the skin, lungs and kidneys. This leads to pathological changes in the organs, to violations of their functions. The disease is characterized by significant skin lesions, fever and weight loss in patients, the appearance of glomerulonephritis (immune damage to the glomeruli of the kidneys) and hemoptysis (pulmonary vasculitis)

Cerebral vasculitis (or vasculitis of the brain) - a serious disease, expressed by inflammation of the walls of the vessels of the brain. May lead to hemorrhage, tissue necrosis. The causes of this type of vascular vasculitis are still being investigated.

Takayasu's disease affects the major arteries of the body, including the aorta. At risk are young women. Signs of this type are weakness and pain in the arms, weak pulse, headaches and vision problems.

Giant cell arteritis (Horton's disease). The process covers mainly the arteries of the head. Characterized by headache attacks, hypersensitivity of the scalp, pain in the muscles of the jaw during chewing, visual disturbances up to blindness.

Shelein-Henoch vasculitis (hemorrhagic vasculitis) is a disease that mainly affects children, but also occurs in adults. The first signs of hemorrhagic vasculitis may appear 1-4 weeks after suffering infectious diseases such as scarlet fever, SARS, tonsillitis, etc. Leads to inflammation of the blood vessels of the skin, joints, intestines and kidneys. It is characterized by pain in the joints and abdomen, the appearance of blood in the urine, redness of the skin on the buttocks, legs and feet.

Cryoglobulinemic vasculitis may be associated with hepatitis C infection. The patient feels general weakness, he develops arthritis, there are purple spots on his legs.

Wegener's granulomatosis causes inflammation of the blood vessels in the nose, sinuses, lungs and kidneys. Typical symptoms of the disease are nasal congestion, as well as frequent nosebleeds, middle ear infections, glomerulonephritis, and pneumonia.

Causes of vasculitis

Doctors cannot yet fully determine the causes of primary vasculitis. It is believed that this disease is hereditary and is associated with autoimmune disorders (autoimmune vasculitis), plus negative external factors and infection with Staphylococcus aureus play a role.

The reason for the development of secondary (infectious-allergic vasculitis) in adults is a past infection.

Other causes of vasculitis include:

• an allergic reaction (to medications, pollen, book dust, fluff);
• autoimmune diseases (systemic lupus erythematosus, thyroid disease);
• vaccination;
• abuse of sunbathing;
• consequences of injuries;
• negative reaction of the body to various chemicals, poisons;
• hypothermia of the body;

Diagnosis of vasculitis

The earlier the examination is carried out, the diagnosis is established and treatment is started, the more likely it is to avoid damage to vital organs and disruption of their functions.

If necessary, consultations of a vascular surgeon, therapist, ophthalmologist, neurologist, otolaryngologist, etc. are appointed.

The diagnosis is made on the basis of a number of data:

• physical examination;

Tests for vasculitis (see also rheumatological examination)

It is necessary to pass the following tests:

• complete blood count (usually an increase in ESR is noted);
• biochemical analysis of blood (protein fractions, etc.);
• immunological tests (gamma globulin, to a rheumatologist. A favorable prognosis is possible only with timely treatment, in the early stages, until the disease has passed into the so-called chronic vasculitis.

  "Vasculitis" is a general term that combines a number of diseases characterized by inflammation of the vascular walls. With such pathologies, blood vessels narrow, and nutrition and oxygen supply to tissues deteriorates. The result is often the death of tissues and a sharp decrease in the functional activity of individual organs, up to their complete failure.

  Treatment of vasculitis is carried out mainly by rheumatologists, but the variety of clinical manifestations often requires examination by doctors of other specializations.

  Classification

  According to the accepted classification, primary and secondary varieties of inflammatory lesions of the vascular walls are distinguished.

  Depending on the type of vessels affected by the inflammatory process, vasculitis is divided into:

  • arteritis (large vessels suffer - arteries);
  • arteriolitis (affected arterioles);
  • phlebitis (inflamed veins);
  • capillaries (small blood vessels are affected).

  

  The group of vasculitis includes the following diseases:

  • hemorrhagic vasculitis (Schonlein-Genoch syndrome);
  • Takayasu's disease (nonspecific aortoarteritis);
  • microscopic polyangiitis;
  • Kawasaki disease;
  • mixed vasculitis;
  • nodular polyarteritis;
  • allergic vasculitis of the skin;
  • 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 currently unclear.

  Secondary lesions of the vascular walls develop against the background 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 (sera);
  • contact with chemicals or biological poisons;
  • genetic factor (hereditary predisposition);
  • thermal factor (overheating or organism);
  • skin (including against the background);
  • injuries of various genesis and localization.

  Important:vasculitis often develops in people who have undergone.

  Any of these factors, as well as a combination of two or more of them, can change the antigenic structure of the body's own tissues, in this case, the walls of blood vessels. The immune system begins to perceive them as foreign, and activates the production of antibodies that further damage blood vessels. Thus, an autoimmune reaction is launched, in which inflammatory and degenerative processes develop in target tissues.

  Symptoms of vasculitis

  

  Clinical manifestations of pathologies of this group largely depend on the nature of the disease, i.e., the specific nosological form. Some vasculitis affect only the skin, causing only minor discomfort to the patient. Others cause multiple lesions of internal organs, leading to the death of a person.

  A symptom common to all vasculitis is a more or less pronounced febrile reaction. An increase in body temperature is a typical reaction of the body to a serious inflammation of any localization. Hyperthermia may be intermittent; for inflammation of the vessels, daily temperature fluctuations are quite characteristic. At the peak of its increase, a skin reaction in the form of rashes often develops.

  Other symptoms often observed in patients with vasculitis include:

  • general weakness;
  • severe physical and mental fatigue;
  • pallor of the skin;
  • myalgia (typical for the nodular form);
  • paresthesia (sensitivity disorders);
  • drop in visual acuity;
  • periodic loss of consciousness ();
  • deterioration or complete lack of appetite;
  • sleep disorders;
  • neuropsychiatric disorders;
  • frequent inflammation of the oral mucosa;
  • swelling in the temporal region (characteristic of Horton's disease);
  • the appearance of non-infectious ulcerative lesions on the genitals (with Behçet's syndrome).

  Typical clinical manifestations of vasculitis include hemorrhages of a small area with primary localization on the skin of various parts of the body. As the process progresses, they appear in the muscle tissue, articular cavities and in the areas of nerve endings.

  Depending on which vessels are affected, a certain organ is predominantly affected. If the renal vessels are affected, kidney infarctions also develop more often. With the localization of inflammation in the coronary arteries, the risk of heart damage is high (up to the conditioned one). When the vessels that feed the articular tissues are affected, symptoms develop first of all, and other signs may appear only after a few weeks or even months.

  Note:Arthritis caused by malnutrition and tissue oxygenation is characterized by the development of a pain syndrome that is not associated with increased physical exertion or injury. Against the background of vasculitis, inflammation usually develops in large joints.

  A characteristic symptom of one of the most common vasculitis is 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 abdomen.

  With damage to the coronary vessels, cardialgia, shortness of breath and heart rhythm disturbances appear.

  Wegener's granulomatosis is characterized by a predominant lesion of the nasal sinuses with the release of blood and pus from the nasal passages.

  For any pathologies of this group, a protracted chronic course is typical with inevitable progression in the absence of treatment. They are also characterized by periodic exacerbations, during which the severity of clinical symptoms increases.

  In the course of laboratory diagnostics in the blood, a decrease in the level of hemoglobin (anemia) and a moderate increase in the number of leukocytes and platelets are often determined.

  In the urine, blood cells (leukocytes and erythrocytes) are determined, i.e. microhematuria occurs; protein is often found.

  Clinical symptoms are for the most part non-specific, therefore, a number of laboratory tests are required to make a diagnosis (to confirm the inflammatory and autoimmune process), as well as hardware research methods -, computed tomography and. Conducted if necessary.

  Treatment of vasculitis, prognosis and prevention

  Therapeutic tactics is selected for each patient individually. When drawing up a treatment plan, the form of vasculitis, the severity of the process and the presence of concomitant pathologies are taken into account.

  The main tasks of therapeutic measures for vasculitis:

  • achieving remission;
  • relapse prevention;
  • prevention of irreversible damage to organs and tissues;
  • reducing the likelihood of complications;
  • increasing the duration and improving the quality of life of the patient.

  The basis of the treatment of vasculitis 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 hormone therapy that allows you to suppress the abnormal activity of the immune system in a short time. If, with a complicated course of the disease, it is not possible to achieve positive results with the help of glucocorticoids, chemotherapy with the use of cytostatics is indicated.

  If a hemorrhagic type of pathology is diagnosed, a rational one becomes a prerequisite for successful treatment.

  A good therapeutic effect in most cases can be achieved by purifying the blood through plasmapheresis and hemosorption techniques.

  With a mild course of the disease and in remission, drugs from the NSAID group () help. Patients, in particular, are prescribed Voltaren and Indomethacin, which allow, among other things, to reduce the intensity of the pain syndrome.

  With vasculitis, drugs are shown that reduce the degree of permeability of the vascular walls and inhibit the process of thrombosis.

  Note:treatment of vasculitis of allergic origin, in which only minor skin lesions are detected, is possible without the use of pharmacological preparations. In this case, the exclusion of the patient's contact with the alleged allergen comes to the fore.

  Forecast

  The prognosis largely depends on the location and severity of vascular inflammation, as well as on the number of affected organs.

  Prevention

  Hardening procedures are recommended to prevent vascular inflammation. One of the important preventive measures is to reduce the influence of adverse external factors on the body and normalize sleep and rest. You should not take pharmacological drugs without a doctor's prescription or get vaccinated unnecessarily. A person must receive all vaccines in accordance with the National Immunization Schedule.

  Sovinskaya Elena, medical columnist

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