Vasculitis (disease) - symptoms and treatment
What is Vasculitis
Vasculitis - a group of AUTOIMMUNE DISORDERS in which the epithelium (lining) of the BLOOD vessels becomes inflamed. The INFLAMMATION causes localized PAIN and swelling. There are numerous forms of vasculitis. They share common characteristics and symptoms though each of which has unique traits. Vasculitis may be acute (come on suddenly, run its course, and be over) or chronic (symptoms persist or come and go). Though vasculitis can affect any kind of blood vessel in the body, it most often involves arteries.
Symptoms of Vasculitis and Diagnostic Path
Each type of vasculitis has unique symptoms. All types of vasculitis have in common these general symptoms:
The doctor may conduct BLOOD tests to measure ANTIBODY types and levels, blood cell counts, and sedimentation rate and C-REACTIVE PROTEIN level (the latter two are indicators of inflammation in the body). Diagnostic imaging procedures such as Doppler ULTRASOUND, MAGNETIC RESONANCE IMAGING (MRI) COMPUTED TOMOGRAPHY (CT) SCAN, and angiogram can demonstrate any damage to or obstruction (blockage) of the arteries and veins. Sometimes a biopsy of the involved blood vessel is necessary to confirm the diagnosis.
| Type of Vasculitis | Unique Symptoms | Treatment and Outlook |
|---|---|---|
| giant cell arteritis (temporal arteritis) | primarily occurs in adults over age 50 affects arteries in the upper body, notably the neck and head (carotid network) severe HEADACHE, jaw PAIN, and scalp tenderness blind spots (scotoma), blurred vision, and other vision disturbances |
high-DOSE corticosteroid medications for two to four weeks long-term corticosteroid therapy delayed treatment establishes high risk for blindness resulting from optic NEUROPATHY tends to be chronic |
| Henoch-Schönlein purpura | primarily occurs in children under age 6 purplish RASH on the legs and feet acute illness that lasts about 2 weeks affects blood vessels of the skin, joints, gastrointestinal tract, and KIDNEYS |
complete recovery without treatment (self limiting course of disease) possible complications, though uncommon, include RENAL FAILURE and GASTROINTESTINAL BLEEDING |
| hypersensitivity vasculitis (leukocytoclastic vasculitis) | affects small arteries in the skin, kidneys, gastrointestinal tract, lungs, and joints palpable (raised) PURPURA, commonly on the legs |
corticosteroid medications or immunosuppressive medications when involvement is systemic symptoms can be recurrent |
| KAWASAKI’S DISEASE (mucocutaneous LYMPH NODE syndrome) | occurs primarily in children under age 5 acute onset with high FEVER lasting five days to two weeks fever does not drop with aspirin or acetaminophen inflamed and reddened eyes, reddened and chapped lips, peeling skin, and joint pain |
high-dose, intravenous GAMMAGLOBULIN aspirin most children fully recover without complications risk for coronary ARTERY INFLAMMATION and aortic ANEURYSM requires lifelong monitoring for CARDIOVASCULAR DISEASE (CVD) |
| microscopic polyangiitis | more common in adults over age 50 affects arteries in the kidneys, skin, lungs, and that serve PERIPHERAL NERVES fever purpura and other skin rashes neuropathy and loss of NERVE function to feet and hands alveolar hemorrhage (bleeding into the tiny air sacs in the lungs) |
corticosteroid medications in combination with immunosuppressive medications trimethoprim/sulfamethoxazole (antibiotic therapy) |
| polyarteritis nodosa | affects arteries in the LIVER, gastrointestinal tract, kidneys purpura and skin ulceration pain in the joints and large muscles abdominal pain HYPERTENSION |
aggressive, high-dose corticosteroid medications at diagnosis immunosuppressive medications for nonresponsive or severe symptoms long-term corticosteroid therapy to control chronic disease antihypertensive therapy untreated or severe disease has high risk for death complications include renal failure, LIVER FAILURE, and HEART FAILURE |
| polymyalgia rheumatica | primarily occurs in adults over age 60 severe pain and inflammation in the large joints (knees, hips, shoulders) |
NSAIDs corticosteroid medications chronic symptoms requiring long-term treatment may indicate underlying giant cell arteritis |
| Takayasu arteritis | affects the AORTA and other large arteries most common in women between ages 20 and 35 pain and weakness in the back and arm on the affected side lower BLOOD PRESSURE in the arm on the affected side headache, dizziness, and vision disturbances hypertension |
corticosteroid medications immunosuppressive medications for severe symptoms ANTICOAGULATION THERAPY such as aspirin or warfarin spontaneous resolution in about 95 percent of people possible complications include STROKE, HEART ATTACK, severe hypertension, aortic aneurysm, and heart failure |
| thromboangiitis obliterans (Buerger’s disease) | most common in men aged 20 to 40 who smoke affects blood vessels in arms, hands, legs, and feet leg cramps with walking (INTERMITTENT CLAUDICATION) altered sensation or loss of sensation in feet (paresthesia) ulcerations on fingers and toes with rapid progression to GANGRENE (tissue death) |
SMOKING CESSATION rest until inflammation subsides regular walking to improve circulation and muscular support for blood vessels aggressive treatment for ulcers that develop AMPUTATION of gangrenous digits or extremities chronic condition that requires diligent lifestyle management to minimize symptoms |
| Wegener’s granulomatosis | more common in men over age 40 affects blood vessels in the NOSE, SINUSES, THROAT, lungs, and kidneys, often causing ulcerations chronic PNEUMONITIS chronic GLOMERULONEPHRITIS forms multiple granulomas |
immunosuppressive medications corticosteroid medications with mild symptoms and early diagnosis trimethoprim/sulfamethoxazole (antibiotic therapy) treatment eliminates symptoms in 50 percent of people severe or untreated symptoms can be fatal outlook best with early diagnosis and treatment |
Vasculitis Treatment Options and Outlook
Some types of vasculitis are self-limiting and do not require treatment. For most, treatment may include NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), CORTICOSTEROID MEDICATIONS, and IMMUNOSUPPRESSIVE MEDICATIONS that have cytotoxic (cellkilling) effects (such as azathioprine and cyclophosphamide). The person may take one kind of medication or a combination of medications, depending on the symptoms and their severity. Nutritional EATING HABITS and daily physical exercise such as walking also aid HEALING and improved function.
Risk Factors and Preventive Measures
Doctors do not know what causes most vasculitis, though people who have autoimmune disorders are more likely to develop some type of vasculitis. Because some forms of vasculitis have potentially severe or life-threatening complications, early diagnosis and treatment are essential for optimal recovery or disease management. Many of the medications doctors prescribe to treat vasculitis have significant side effects such as OSTEOPOROSIS so it is important to be vigilant about such conditions.
See also ARTERY; ATHEROSCLEROSIS; HYPERSENSITIVITY REACTION; LIVING WITH IMMUNE DISORDERS; OPPORTUNISTIC INFECTION; RHEUMATOID ARTHRITIS; SYSTEMIC LUPUS ERYTHEMATOSUS (SLE); VEIN.
