The prevalence of vasculitis varies in different countries from 0.4 to 14 patients per 100 thousand population. Twenty-five percent of the total suffer from a rheumatoid form of vascular inflammation.
However, in the last quarter century there has been a trend towards an increase in the number of patients with rheumatoid vasculitis. There are 2 reasons for this:
- environmental degradation and stress;
- increased the quality of diagnosis, so that vasculitis became more common.
Rheumatoid arteritis is found mainly in older people - 50-60 years.
Symptoms
Rheumatoid arteritis as a form of vasculitis according to the type of occurrence happens:
- primary , when erupts as an independent disease;
- Secondary , that is, develops as a consequence of another disease. And if it comes to the secondary nature of rheumatoid vasculitis, it is noted that one of the prerequisites for inflammation of the vessels is inflammation of the joints - rheumatoid arthritis.
Classical signs of the RV are:
- Pericarditis ( inflammation of the heart membrane).Moreover, this disease doctors consider the first signal for the occurrence of vasculitis. But in this situation, RV is primary, that is, pericarditis is a consequence of arteritis.
If a patient has pericarditis, other causes should be sought that indicate rheumatoid vasculitis. Together with pericarditis for the presence of rheumatoid inflammation of the vessels indicate:
- Fever , changes in body temperature;
- Fast fatigue , weakness;
- Migraine , joint aches.
In the future may appear:
- Multiple mononeuritis( inflammation of individual nerves);
- Scleritis( inflammatory brain damage);
- Lesion of the lungs;
- Sharp weight loss.
Risk Factors
The etiology of primary rheumatoid vasculitis is not known exactly. The cause is autoimmune damage. Other suspected factors include:
- Infectious diseases. It is with the broken immunity that infections of various etiologies take possession of the human body. So these two reasons are interrelated.
- Excessive use of medications, especially those that enter the body intravenously: vaccines, serums.
- Genetic factor plays an important role.
- Physical effects, such as hypothermia, burns, injuries and especially radiation radiation.
The prerequisites for the development of secondary arteritis are the underlying diseases that caused the inflammatory process of the vessels. Doctors observing the course of the disease drew attention to one important regularity: rheumatoid vasculitis most often appears in patients suffering from "protracted" rheumatoid arthritis .
In other words, the inflammation of the joints is transmitted to the blood vessels that are near, and, obviously, the disease with blood is transferred to other parts of the circulatory system.
Histological classification
Conditionally rheumatoid arteritis can be divided into three clinical-histological types:
- Finger arteritis with proliferation of the inner layer of vessels under the external muscular membrane;The name finger, or digital, this type of vasculitis has received, because, first of all, the nail phalanges of the fingers of the upper and lower extremities are affected. Of all types of RV occurs more often than others. However, doctors disagree on the issue of digital arteritis. Some of them believe that the nail phalanx is affected not by vasculitis, but by arthritis, which accompanies RV.
- Inflammation of small vessels - venules, arterioles and capillaries of the skin. The disease is characterized by pathological proliferations of the connective tissue of the vessels with their subsequent necrosis and filling of pathogenic cells with a mononuclear infiltrate. It is characterized by skin signs - ulcers and palpable purple.
- Necrotizing arteritis , involving not only small and medium vessels in the pathological process, but also internal organs and peripheral nerve endings.
To which doctor to go
Diagnosis of rheumatoid inflammation of blood vessels is often complicated:
- comparative rarity of this disease;
- multiplicity of symptomatic manifestations;
- the ability to mask for other diseases.
For example, the patient takes the skin for an allergy or other skin disease and goes to the dermatologist. Problems with the heart are treated by a cardiologist, but with kidney problems go to the nephrologist.
So who should you treat with blood vessel problems? First of all, the patient should consult the therapist , who will send him for the diagnostic procedures.
To treat rheumatoid vasculitis should be involved hematologist, cardiologist and rheumatologist .Treatment of such patients should be developed in a complex, taking into account what organs have suffered. It may be necessary to consult a nephrologist and dermatologist.
Diagnosis
To make an accurate diagnosis of rheumatoid vasculitis, a detailed examination is performed, which allows excluding diseases with similar symptoms. All examinations should be confirmed by biopsy data from the tissues under investigation. The examination should be carried out in a hospital. The laboratory study includes:
- complete blood count;
- creatinine content;
- presence of hepatic enzymes;
- general urine analysis.
In order to exclude a number of diseases, the following studies are carried out:
- The assumption of the presence of myopathy serves as the basis for the appointment of a study of creatine phosphokinase;
- To exclude infection, a bacteriological study of blood is performed.
- Serological testing of blood helps to exclude syphilis. Cutaneous ulceration is similar to lesions that occur with syphilis. Therefore, it is important to exclude or confirm this infection.
- The analysis for rheumatoid and antinuclear factors is performed with the aim of eliminating systemic rheumatic pathology;
- The presence of antineutrophilic cytoplasmic antibodies to confirm such forms of vasculitis as Wegener's granulomatosis, microscopic polyangiitis, Charge-Strauss syndrome.
- Analysis of APL excluding primary antiphospholipid syndrome.
Instrumental diagnostics is presented:
- Angiography of , which is performed if it is impossible to take tissue for examination, or non-specific results are required. This method allows to identify nodular multiple arteritis. It is recommended instead of biopsy of the kidneys or liver to detect microneurism, which can lead to bleeding when the tissue samples are taken.
- Angiography will also detect arteritis Takayasu, occlusive thromboangiitis, evaluate dynamics and localization of pathology.
- Duplex ultrasound will also show the pathology of the vessels with the same forms of vasculitis.
- Radiography of the lungs will show the extent of their involvement in microscopic polyangiitis, Wegener's granulomatosis, Charge-Strauss syndrome.
- MRI or CT will show the localization of the inflammatory process.
Principles of treatment
Rheumatoid arteritis is considered incurable, and therefore the main goal of treatment activities is:
- remission,
- decrease in the possibility of exacerbations,
- prevention of destruction of internal organs.
Treatment is selected individually for each patient, depending on the degree of involvement of internal organs, parts of the circulatory system. But the main direction in the treatment is the method suppression of immunity, with simultaneous therapy with antibiotics .
The most effective treatment for rheumatoid vasculitis is considered pulse therapy,( short-term therapy with shock doses), intermittent cyclophosphamide with prednisolone.
Sometimes chlorambucil is prescribed for a short period, but prolonged use of this drug is not recommended because of the possible occurrence of malignant tumors. Shock therapy allows you to achieve a stable remission in a short time.
As an adjunct to the main treatment, dipyridomole is used, which protects erythrocytes from deformation.
In the presence of signs of cryoglobulinemia and severe forms of vasculitis plasmapheresis is recommended( collection of blood from the patient for purification and return to the circulatory system).
Forecast
Vasculitis, in whatever form it may be expressed, the disease is very serious, and therefore it should be treated with all responsibility. Here are a few data that clearly demonstrate the prognosis of survival with correctly chosen methods of treatment.
Practice shows that the use of hormonal therapy with glucocorticoids in combination with cytostatics in nodular polyarteritis provides survival for at least 5 years in 62-78 percent. The main percentage of mortality is in the first year of illness. The reason - cardiovascular pathology, central nervous system diseases, kidney, digestive tract .
The treatment of microscopic polyarteritis provides a five-year lifespan of patients after treatment in 65 percent. Mortality is due to pulmonary hemorrhage, complications associated with infections. The prognosis also depends on kidney condition .
Treatment of arteritis Takayasu gives survival to 15 years in 80 percent. The cause of death is heart attacks and strokes .
In the treatment of giant cell arteritis, a five-year survival rate of 100% is provided, but there is a danger of complications, primarily a violation of the arteries of the eyes, which can lead to irreversible blindness of .
Consequences of
Vasculitis is no less dangerous than atherosclerosis, since on the one hand leads to destruction of the walls of blood vessels, their fragility, and as a consequence, to internal hemorrhages of .On the other hand, the destruction of the walls of blood vessels can block blood flow to the organ, as a result of which, necrosis of this organ can develop due to a lack of oxygen.
Therefore, preventive measures play not the least role in maintaining the health of the blood vessels and the whole organism as a whole. Data from preventive measures will not require the patient to make much effort .It is necessary only:
- Take care not to overcool;
- Do not stay in the sun for a long time. Sunburn is especially contraindicated to those who have RV manifested hemorrhages on the skin.
- Do not allow heavy physical exertion;
- Avoid alcohol and allergenic foods such as oranges, eggs, chocolate.
- Avoid contacts with chemicals;
- Warn and destroy foci of infection;
- Timely treatment.
Is it possible to maintain health and activity in this disease? Everything will depend on the attitude to yourself and to your own patient's illness. It is important to comply with all the prescriptions of the doctor, in a timely manner to undergo a course of treatment.
is also important as a psychological attitude of : it does not mean that one should fixate on one's own illnesses. There are patients who love their illnesses, like to complain and talk about them, provoking sympathy in others. But such self-pity is a direct way to the grave. It is important to love yourself, not the illness in yourself. Do not avoid homework and lie around all day on the couch.
It is necessary to avoid stress, and on the contrary, you need to find an extra reason for joy. Communicate with family and friends. Even a walk through the forest or park, if desired, can be turned into a small holiday. Strive to live positively, enjoying every day, and the disease can retreat.
