Vasculitis - treatment methods, diet, traditional medicine, consequences, prognosis and prevention of the disease

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). If untreated, the primary focus may spread and cause damage to other tissues or organs. Subsequently, the disease can lead to disability and even death.

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

What it is?

Vasculitis is a pathological condition of the body in which the walls of blood vessels of various calibers become inflamed: capillaries, venules, arteries, veins, arterioles. They can be located in the dermis, on the border with the hypodermis, or in any other body cavity. Vasculitis is not a single disease, it is a group of pathologies that are combined on a single basis.

Doctors distinguish several types of ailment, differing in the place of localization, the severity of the process, etiology:

  1. Primary. It starts as an independent disease with its own symptoms.
  2. Secondary. It develops in the presence of other pathologies (tumors, invasion). May occur as a reaction to infection.
  3. Systemic The disease is different. It is characterized by vascular damage with inflammation of the vascular wall, may be accompanied by necrosis.

Classification

In medicine, there are several classifications of this disease. One of the criteria for determining its species is the caliber of blood vessels. Given this factor, vasculitis disease is divided into the following forms:

  1. Capillaritis. It consists in the defeat of small vessels (capillaries). In this case, there may occur: Dego's disease, urticaria vasculitis (urticaria), Schamberg's pigmented purpura, Wegener's granulomatosis.
  2. Arteriolitis. It is an inflammation of medium-caliber vessels (arteries and arterioles). It is manifested by lepromatous arteritis, polyarteritis nodosa, Kawasaki disease, familial Mediterranean fever, striatal vasculopathy.
  3. Arteritis. This is a lesion of large vessels (artery walls). These include giant cell arteritis, Takayasu disease, Kogan syndrome, sarcoidosis, tropical aortitis.
  4. Phlebitis. With this form of vasculitis, inflammation of the walls of the veins occurs.
  5. Vasculopathy. With this ailment, there are no clear signs of inflammatory-cell infiltration of the vascular wall.

Due to the development, the disease is divided into two forms: primary (formed as an independent pathology) and secondary (formed against the background of other diseases). Given the degree of vascular damage, vasculitis happens:

  • mild - with mild rash, burning and itching,
  • moderate - with severe spots ranging in size from a few millimeters to 1-2 cm, weakness, loss of appetite, pain in the joints,
  • severe - with numerous rashes, intestinal and pulmonary hemorrhages, significant changes in the joints and internal organs.

Reasons for development

Primary vasculitis is considered by specialists as an independent nosological form.The exact causes of this disease to date remain unclear.

Secondary lesions of the vascular walls develop against the backdrop of a wide variety of pathologies. Possible causes of secondary vasculitis:

  • infections (both acute and chronic),
  • individual body reaction to the introduction of vaccines (sera),
  • contact with chemicals or biological poisons,
  • genetic factor (hereditary predisposition),
  • thermal factor (overheating or hypothermia of the body),
  • skin burns (including against the background of prolonged insolation),
  • injuries of various genesis and localization.

Important: vasculitis often develops in people who have had viral hepatitis.

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 additionally damage blood vessels. In this way, an autoimmune reaction is triggered, in which inflammatory and degenerative processes develop in the target tissues.

First signs

Regardless of shape and type, most vasculitis (see photo) occur with similar symptoms. The most characteristic symptoms of pathology:

  • loss of appetite, followed by weight loss,
  • decrease in body temperature
  • the appearance on the skin of unaesthetic rashes,
  • constantly haunting joint pain
  • pallor of the skin,
  • fatigue, weakness, malaise,
  • frequent sinusitis,
  • regular exacerbations of heart and vascular diseases,
  • nausea and vomiting,
  • violation of sensitivity - from minimal to pronounced,
  • myalgia and arthralgia.

The clinical manifestations of the disease can vary depending on the type of vasculitis and its location. In this case, the main symptom of the pathology, in any case, remains a violation of normal blood circulation in the organs and systems of the body.

Symptoms of vasculitis

Symptoms of vasculitis (see photo) are extremely diverse, and the most characteristic external manifestation of vasculitis 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 ailment can cause disability or death.

Signs of skin rashes with vasculitis can be varied, but a number of them can distinguish this ailment from others:

  • the appearance of a rash is often associated with a previous infection,
  • the rash appears against the background of an allergy, systemic, autoimmune or rheumatic disease,
  • the rash is relatively symmetrical,
  • the first elements of the rash appear precisely on the legs (usually in the shin area),
  • elements of the rash are prone to hemorrhages, swelling and necrosis,
  • the rash is often represented by different elements that change their color, size and shape over time.

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

  1. Stains. They are red or pink, not rising above the level of the skin elements of the rash. 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 spots or a purple-colored telangiectasia. 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 appears in the form of pink or red bubbles with irregular contours.
  4. Subcutaneous nodes. Such rash elements are caused by the uncontrolled growth of connective tissue and epidermis.They are towering semicircular or flat nodules. Their size can vary from a few millimeters to 1-2 cm. They are painful, and over time a necrosis site may appear in their center due to a significant violation of blood circulation. Subsequently, the skin in this place of the nodule blackens and begins to be torn away.
  5. Bubbles Violations of the permeability of the vascular walls in a certain section 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 in which blood inclusions may be present.
  6. Ulcers and erosion. Subcutaneous nodules formed during vasculitis disintegrate over time, and erosion (superficial damage) or deeper skin defects, ulcers, occur in their place. When infected, they can suppurate.

Pictured are external manifestations of vasculitis: rash on the legs

Damage to the nervous system

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

  • sudden changes in the psycho-emotional state,
  • bouts of cramps
  • muscle weakness, incomplete paralysis of the arms and legs,
  • changes in sensitivity (more often in the form of “socks” and “gloves” - that is, in these areas of the body),
  • cerebral hemorrhages leading to the development of hemorrhagic stroke.

Intoxication

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

  • 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),
  • fever up to 37.5-40 degrees (depending on the severity of the disease).

Definitions of the main nosological forms of systemic vasculitis.

NameDefinition
Hemorrhagic vasculitis (Schonlein-Genoch purple) Vasculitis with immune deposits of IgA, affecting small vessels (capillaries, venules, arterioles). Lesions of the skin, intestines and kidneys are typical in combination with arthralgia or arthritis.
Cryoglobulinemic vasculitis Vasculitis with cryoglobulinemic immune deposits, affecting small vessels (capillaries, venules, arterioles) and combined with serum cryoglobulinemia. The skin and glomeruli of the kidneys are often affected.
Cutaneous leukocytoclastic vasculitis Isolated cutaneous leukocytoclastic angiitis without systemic vasculitis or glomerulonephritis.
Microscopic polyangiitis Necrotizing granulomatous inflammation involving the respiratory tract and necrotizing vasculitis of small and medium caliber vessels (capillaries, venules, arterioles, arteries). Often, necrotizing glomerulonephritis develops.
Granulomatosis with polyangiitis (Wegener) Necrotizing granulomatous inflammation involving the respiratory tract and necrotizing vasculitis of small and medium caliber vessels (capillaries, venules, arterioles, arteries). Often, necrotizing glomerulonephritis develops.
Eosinophilic granulomatosis with polyangiitis (Cherdzha-Stros) Eosinophilic, granulomatous inflammation involving the respiratory tract and necrotizing vasculitis of small and medium-sized vessels. Combined with bronchial asthma and eosinophilia.
Polyarteritis nodosa Focal necrotizing inflammation of the arteries of predominantly medium caliber of any location with the formation of aneurysms, thrombosis, rupture of aneurysms with bleeding, heart attack of affected organs and tissues. Not accompanied by glomerulonephritis or damage to arterioles, capillaries and venules.
Kawasaki disease Inflammation affecting the large, medium and small arteries, combined with mucocutaneous lymphatic syndrome.Arteries and veins may be involved. Coronary arteries are often affected. Commonly found in children
Giant Cell Arteritis (Horton's Disease)

Giant cell arteritis - granulomatous arteritis of the main branches of the aorta, mainly extracranial branches of the carotid artery with frequent damage to the temporal artery. It usually begins in patients older than 50 years and is often combined with rheumatic polymyalgia.

Rheumatic polymyalgia is a clinical syndrome that develops in the elderly and senile, characterized by pain and stiffness in the shoulder and pelvic girdle, a sharp increase in ESR.

Arteritis Takayasu Progressive granulomatous inflammation of the aorta and its main branches. Young women are most prone to the disease.

Respiratory problems

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

  1. prolonged runny nose.
  2. protracted sinusitis and sinusitis.
  3. destruction of the bony walls of the maxillary sinus or nasal septum.
  4. protracted bronchitis with an asthmatic component.
  5. bronchial asthma.
  6. pleurisy.
  7. pneumonia.
  8. bronchiectatic disease.

When the walls of the vessels rupture, the patient develops broncho-pulmonary hemorrhages of different intensities.

Clinic

Features clinical course of HPA

HPA is characterized by a triad of organ damage involving the upper respiratory tract (VDP), lungs and kidneys.

In the vast majority of patients (more than 90%), necrotizing granulomatous inflammation of the airway syndrome develops: ulcerative necrotic rhinitis, sinusitis, damage to the hearing organ, involvement of the trachea and larynx with the formation of a sub-granuloma. The pathology of airborne infections can be complicated by perforation of the nasal septum with the formation of a saddle deformity of the nose, the development of severe destructive pansinusitis with the spread of granulomatous tissue into orbit, hearing loss, stenosis of the larynx.

Damage to the lungs (50-70%) is characterized by necrotizing granulomatous inflammation, which is determined by x-ray examination in the form of nodes or infiltrates, prone to decay and cavity formation. In every fifth case, lung damage is asymptomatic, with no complaints of coughing and a scanty auscultatory picture, even with severe damage.

Kidney damage is noted in 80% of patients.

To damage the organ of vision (50%), the formation of the pseudotumor of the orbit due to the formation of periorbital granuloma is characteristic, which in every fifth patient leads to blindness.

Skin lesion (25-35%) is primarily characterized by hemorrhagic or ulcerative hemorrhagic rashes mainly on the skin of the limbs.

For the defeat of the peripheral nervous system, the development of asymmetric sensory-motor multiple mononeuritis is characteristic (20-30%), distal symmetric polyneuropathy is much less common. Every fourth GPA patient with hearing damage develops secondary (odontogenic) neuritis V, VII of the cranial nerve pair.

Damage to the heart with HPA does not exceed 20%. As with all ANCA-SV patients, HPA increases the risk of cardiovascular diseases (CHD, stroke, peripheral arterial occlusion), while there is an increased risk of AMI, but not angina pectoris.

Damage to the gastrointestinal tract (GIT) is rare (5%).

Among patients with HPA, the risk of exacerbation is higher (65%) than with MPA or EGPA (35%), while relapses persist at high cumulative doses of CF.

Clinical features MPA course.

In 50% of patients, MPA is manifested in the form of severe pulmonary-renal syndrome. As a rule, with MPA, an acute onset and a more aggressive course are observed than with HPA or EGPA.

MPA has many common features with HPA, characterized by the absence of granulomatous inflammation, as a result of which MPA is not peculiar to subclavicular laryngitis, saddle nose deformation, periorbital granulomas.

Pathology of the lungs (35-70%) with MPA is represented by necrotizing alveolitis. An X-ray examination reveals infiltrates without decay, often with a pleural reaction. Damage to the lungs with MPA is severe (especially in the presence of antibodies to proteinase-3), in half of patients complicated by pulmonary hemorrhage, which in every second case becomes fatal. In MPA with hyperproduction of antibodies to myeloperoxidase, cases of fibrosing alveolitis have been described.

Kidney damage is observed in 90% of patients and is often characterized by a rapidly progressive course (40-55%), especially severe in the presence of antibodies to PR-3.

Skin lesion (70%) is characterized by hemorrhagic or ulcerative hemorrhagic rashes mainly on the skin of the extremities, less often livedo reticularis, skin necrosis and underlying soft tissues.

For damage to the organ of vision (30%), the development of scleritis and episiscleritis is characteristic.

Damage to the peripheral nervous system (30%) is manifested by asymmetric sensory-motor multiple mononeuritis.

A gastrointestinal tract lesion (10%) is characterized by abdominal pain, diarrhea, and sometimes bleeding due to the development of ischemic ulcers of the stomach and intestines.

Features of the clinical course of EGPA.

The clinical development of EGPA is divided into 3 stages, which, as a rule, consistently unfold over several years. The first stage is characterized by a gradual development of symptoms of bronchial asthma, allergic rhinitis, sinusitis, manifestations of drug intolerance, while peripheral eosinophilia is not always expressed. At the second stage, episodes of eosinophilic tissue infiltration in the form of eosinophilic pneumonia or gastroenteritis are added, which is often combined with peripheral eosinophilia of more than 10%. The third stage of EGPA is characterized by the development of systemic necrotizing vasculitis.

Damage to the lungs (70%) is characterized by migrating infiltrates (eosinophilic pneumonia) or nodes without decay cavities. It may involve pleura (eosinophilic pleurisy), a moderate increase in intrathoracic lymph nodes.

Kidney damage is noted in 20-45% of patients.

Damage to the heart (30-50%) with EGPA is manifested by a variety of pathologies (pericarditis, endomyocarditis, coronaritis, heart failure, rhythm and conduction disturbances) and causes death in 50% of patients.

Skin lesions (64%) are characterized by hemorrhagic or ulcerative hemorrhagic rashes mainly on the skin of the extremities, less often by urticarian rashes.

Damage to the peripheral nervous system (64%) with EGPA develops more often than with other forms of ANCA-SV and is characterized by asymmetric sensory-motor multiple mononeuritis. Damage to the central nervous system (10%) can be manifested by neuritis of the cranial nerves, acute cerebrovascular accidents, focal changes in the brain, and epi-syndrome.

To damage the organ of vision (30%), scleritis and episiscleritis are characteristic.

The defeat of the gastrointestinal tract (10%) is associated with both eosinophilic gastroenteritis and vasculitis of the intestinal wall, which can cause the formation of ischemic ulcers and perforation.

Features of kidney damage in ANCA-SV.

Diseases related to ANCA-SV have common morphological changes in the kidneys, similar pathogenesis, clinical course and prognosis. The distinctive features of the clinical course of ANCA-associated GN include:

  • combination with other systemic manifestations of necrotizing vasculitis,
  • a tendency to rapidly progressive course (BPHN) with a decrease in GFR of more than 50% in a few weeks or months,
  • moderate arterial hypertension,
  • proteinuria not exceeding 3 g per day.

ANCA-GN can be manifested by asymptomatic proteinuria and microhematuria (rarely macrohematuria), BPHN, acute non-syndrome. The development of nephrotic syndrome or malignant arterial hypertension is not characteristic. Most often, BPHN develops with MPA (40–55%), especially severe in the presence of antibodies to PR-3. GN can be a debut manifestation of ANCA-SV or join in the course of subsequent exacerbations, and therefore, careful monitoring of renal damage indicators throughout the course of the disease is required.

Vision problems

The insufficient blood supply and nutrition of the organs of vision observed with vasculitis can cause their one- or two-sided lesion:

  • constantly progressive visual impairment (up to complete blindness),
  • swelling and redness of the eye,
  • difficulty feeling when moving the eyeball,
  • protrusion of the eye.

Diagnostics

Laboratory Diagnosis of ANCA-SV.

Of primary importance is the determination of ANCA in serum by indirect immunofluorescence (using neutrophils from healthy donors fixed with ethanol) or using an enzyme-linked immunosorbent assay to determine specificity for proteinase-3 (PR-3) or myeloperoxidase (MPO). An increase in ESR, CRP concentration, normochromic normocytic anemia, moderate thrombocytosis is characteristic.

ANCA with a cytoplasmic type of immunofluorescence luminescence (CSCA) or antibodies to PR-3 are highly sensitive and specific for HPA (more than 90%). ANCA with a perinuclear type of luminescence (PANCA) is found in 70% of patients with EHPA, but not always with specificity for MPO. With MPA and idiopathic BPGN, antibodies to PR-3 / CANCA and antibodies to MPO / Panza are found at approximately the same frequency. It is well known that ANCA, being an important diagnostic marker for ANCA-GN, is of low value for monitoring the activity of the disease, since it can be present in blood serum even during complete clinical remission of the disease.

(Level of evidenceA): An ANCA study using the NIF and / or ELISA should be carried out in accordance with the clinical situation.

Clinical indications for determining ANCA include:

  • glomerulonephritis, especially rapidly progressing
  • hemoptysis / pulmonary hemorrhage, especially in combination with glomerulonephritis
  • skin vasculitis, accompanied by systemic manifestations
  • multiple foci of lung damage during x-ray examination
  • chronic destructive lesion of the upper respiratory tract
  • prolonged course of sinusitis or otitis media
  • lining of the larynx / trachea
  • multiple mononeuritis or other peripheral neuropathy
  • orbit pseudotumor

Histological research at ANCA-SV.

(Level evidence C): Positive biopsy data play a large role in confirming vasculitis.

A biopsy of the nasal mucosa in patients with HPA reveals destructive-productive vasculitis and giant cell necrotizing granulomas. A biopsy of the orbit tissue in the case of HPA with pseudotumor of the orbit is necessary for differential diagnosis with various benign and malignant neoplasms, in particular with an IgG-associated disease. The diagnostic value of an extremely rarely performed open lung biopsy is significantly higher than a transbronchial or biopsy of the nasal mucosa and sinuses. A biopsy of a musculocutaneous flap in patients with EGPA reveals a pattern of destructive-productive vasculitis with eosinophilic infiltration.

A kidney biopsy (with the mandatory use of immunoluminescent microscopy) confirms the diagnosis of ANCA-GN in the presence of fibrinoid necrosis of the glomerular capillaries and arterioles, extracapillary proliferative GN with epithelial and / or fibroepithelial “semilunations” in the glomeruli combined with the absence of immune deposits in the tissue of the kidney. Indications for a diagnostic kidney biopsy are:

  • nephropathy of unknown origin with proteinuria greater than 1 g / l, persistent or recurrent glomerular hematuria,
  • acute or subacute renal failure with symptoms of GN or with systemic manifestations.

2.2 Principles of nodular diagnosis polyarteritis.

Crucial in the diagnosis of polyarteritis nodosa (UP) belongs to a detailed examination of the patient with the identification of pathognomonic symptoms (table 6) The need for early diagnosis is dictated by the need for aggressive therapy until the development of damage to vital organs.

Kidney damage

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

  • lower back pain
  • fever,
  • swelling
  • decreased urine output,
  • protein and blood in the urine.

Subsequently, circulatory and nutritional disorders in the renal tissues become more pronounced, and the tissues of these organs are affected more massive. Due to such changes, the patient develops acute, and then chronic renal failure.

Gastrointestinal tract

Damage to the walls of the vessels of the mesentery and intestines causes circulatory disorders and leads to hemorrhages. As a result, an inflammatory reaction develops and the following symptoms appear in a patient with vasculitis:

  • paroxysmal and intense abdominal pain, aggravating half an hour after eating,
  • nausea and vomiting,
  • rapid stools of a watery nature (sometimes with blood inclusions).

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

Treatment

A rheumatologist, depending on the classification of the disease, may prescribe the following treatment:

For vasculitis in children, transfusion therapy, cytostatics, glucocorticoids are included in the treatment. The treatment needed for hemorrhagic vasculitis is antibiotics.

The main goal of SV pharmacotherapy is to suppress the immunopathological reactions underlying the disease. Pathogenetic therapy is divided into three stages:

  • induction of remission by a short course of aggressive therapy,
  • maintaining remission with the help of long-term (0.5–2 years) immunosuppressant therapy in doses sufficient to achieve stable clinical and laboratory remission,
  • relapse treatment.

Pathogenetic therapy is accompanied by measures aimed at reducing the risk of comorbid diseases and the treatment of complications.

Treatment of patients with SV should be carried out by rheumatologists (as an exception, a general practitioner, but with the advisory support of a rheumatologist) with the involvement of specialists from other medical specialties (nephrologists, dermatologists, hematologists, cardiologists, neuropathologists, psychiatrists, etc.) and be based on close interaction between the doctor and the patient (level of evidence: C).

(Level evidence D): Management SV patients with lesions of small and medium vessels are recommended to be carried out in close contact with centers with sufficient experience in this area.

Patients should be advised to avoid factors that can provoke an exacerbation of the disease (intercurrent infections, stress, insolation, unmotivated medication, etc.), stop smoking, seeks to maintain normal body weight (level of evidence: C). Patients with SV have an increased risk of developing intercurrent infections, atherosclerosis, arterial hypertension, diabetes, and malignant diseases, which significantly increases mortality. Patients with an increased risk are subject to observation and examination together with specialized specialists.

Main groups medicines:

Glucocorticoid Monotherapy (GC) occupies a major place in the treatment of Takayasu arteritis and HCA, allowing to achieve remission and maintain it in most cases. A very quick response to the use of HA can be considered as a diagnostic sign of HCA and RPM.

Combination therapy cyclophosphamide and HA shown with ANCA-SV, severe forms of hepatitis B, classical UE, cryoglobulinemic vasculitis, refractory course of Takayasu arteritis and HCA. Treatment with CF continues for 3-12 months. A longer intake is associated with a high frequency of adverse reactions, primarily infectious. The use of CF in the regime of pulse therapy in comparison with the appointment inside allows you to reduce the cumulative dose while maintaining the therapeutic effect and reduce the frequency of adverse reactions. With an increase in serum creatinine or in an elderly patient, lower doses of CF are used (table 11) With the appointment of CF inward, the dose should be reduced by 25-50%.

Genetically engineered anti-B-cell rituximab therapy (level evidence A) is used in patients with ANCA-SV. Treatment of RTM in these diseases is comparable in efficacy with CF, which is combined with the lack of evidence of an increase in the incidence of severe infectious complications. As a first-line drug, the administration of RTM may be preferred in cases where, for various reasons, the appointment of CF is undesirable.

Contraindication for the appointment of RTM is the presence of a positive intradermal tuberculin test, infection with hepatitis B virus, a significant decrease in serum IgG, neutropenia.

Plasmapheresis (level of evidence A) is recommended for the treatment of individual SV patients with BPHN as a procedure to improve the prognosis of renal function. The combination of standard pathogenetic therapy and plasmapheresis in patients with heart failure with severe kidney damage reduces the risk of developing terminal renal failure, but does not improve the overall survival of patients.

Azathioprine in combination with HA prescribed as induction therapy for hepatitis B, in cases of inefficiency or intolerance to methotrexate (MT) in Takayasu arteritis and HCA, as a supportive treatment after an induction course in ANCA-SV, classical UE, cryoglobulinemic vasculitis.

During the treatment period, AZ monthly monitor laboratory parameters: the number of leukocytes and platelets of peripheral blood, the activity of ALT, AST. With a decrease in the number of leukocytes less than 2.5 · 10 9 / l, platelets less than 100 · 10 9 / l, an increase in the concentration of ALT / AST more than 3 times from the upper limit of the norm, treatment is stopped until the toxic effects are stopped.

Leflunomide may be recommended if there are contraindications (or poor tolerance) for the appointment of AZA.

Methotrexate indicated for refractory Takayasu arteritis and HCA in combination with HA.

During the treatment period, MT monthly monitor the number of leukocytes and platelets of peripheral blood, the activity of ALT, AST. With a decrease in the number of leukocytes less than 2.5 · 10 9 / l, platelets less than 100 · 10 9 / l, an increase in the concentration of ALT / AST more than 3 times from the upper limit of the norm, treatment is stopped until the toxic effects are stopped.

Mofetila mycophenolate prescribed as alternative therapy for patients with refractory or recurrent course of SV. Since its renoprotective properties have been established, it may have certain advantages in the treatment of SV with kidney damage.

During the treatment period, MMF monthly monitors the number of leukocytes and platelets of peripheral blood, the activity of ALT, AST. With a decrease in the number of leukocytes less than 2.5 · 10 9 / l, platelets less than 100 · 10 9 / l, an increase in the concentration of ALT / AST more than 3 times from the upper limit of the norm, treatment is stopped until the toxic effects are stopped.

Normal human immunoglobulin prescribed iv in severe kidney damage, the development of hemorrhagic alveolitis, in cases of attachment of serious infectious complications.

Other medicinal facilities

Antimicrobial (trimethoprim / sulfamethoxazole) and antiviralpreparations (interferon alpha, vidarabine, lamivudine) may be of particular importance in the treatment of patients with heart failure with proven involvement of infectious factors in the development of the disease. A particular problem is the treatment of SV associated with hepatitis viruses, which is carried out in close cooperation with hepatologists.

Since systemic vascular immune inflammation is usually accompanied by hypercoagulation and vasoconstriction, the use of drugs of the following groups is important in the complex treatment of patients with SV:

antiplatelet agents (low doses of acetylsalicylic acid, dipyridamole),

anticoagulants (heparin, warfarin),

Preventive activityaimed at reducing the risk of comorbid diseases and treatment of complications:

· hemorrhagic cystitis, bladder cancer (CF)) - increase in fluid intake (up to 3 l in day) before applying CF and for the next 72 hours, frequent urination, preventive intravenous administration of 2-mercaptoethanesulfonate sodium (Mesna),

(Level of evidenceFROM): A thorough examination of patients with persistent hematuria who had previously received CF therapy due to the high incidence of bladder tumors was shown.

· pneumocystis pneumonia (CF)- trimethoprim / sulfamethoxazole 400/80 mg per day or 800/160 mg every other day.

· toxic methotrexate effect- folic acid,

· gastritis, stomach ulcer (GC)- blockers H2histamine receptors or proton pump inhibitors

· osteoporosis (GK)- preparations of calcium and vitamin D, bisphosphonates.

Without treatment, vasculitis and its variants may entail:

  • renal hepatic failure,
  • pulmonary hemorrhage
  • abscesses of the abdomen
  • polyneuropathy
  • intestinal invagination.

Causes of Vasculitis

What is this disease, and what are the causes of vasculitis: the main cause of this disease is inflammation of the walls of blood vessels. Most often, vasculitis occurs on the legs, the treatment of which must begin in a timely manner.

  1. The etiology of primary vasculitis is still not precisely established. Autoimmune disorders are considered the main possible cause.
  2. Secondary vasculitis can occur against the background of chronic, acute infections, vaccinations, cancer, severe overheating or cooling, thermal skin lesions, including sunburn.

Often, the disease occurs due to an allergic reaction to medications. Currently, more than 150 drugs are known, the intake of which triggers the development of vasculitis. These funds include: sulfa drugs, radiopaque substances, B vitamins, tuberculostatics, analgesics, iodine preparations, antibiotics, etc. In addition, attention should be paid to allergic manifestations after the introduction of certain vaccines, serums. This is especially true for children.

Each of these factors can cause the beginning of the process of changing the antigenic structure of the tissue, which forms the basis of blood vessels. As a result, the autoimmune process starts, in which the body begins to perceive the body's own tissues as foreign. As a result, the human immune system begins to attack its own tissues, damaging the blood vessels.

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. It is the knee joints that are the first to suffer the most, and the patient has the following symptoms:

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

After a few days, the inflammatory process moves to adjacent joints and knee pains become weaker. Typically, such joint damage is self-healing and does not lead to irreversible consequences.

Diet for vasculitis

The diet of a patient with vasculitis is compiled taking into account the causes that entailed the development of the disease. First of all, such a diet is aimed at eliminating the possibility of allergic reactions. Therefore, during an exacerbation and for some time after it, the patient must adhere to a strict hypoallergenic diet.

Do not refuse to eat fresh vegetables, fruits (with the exception of those that provoke allergies), dairy products, in particular cottage cheese, dried fruits, various cereals. For example, some drugs increase blood pressure, which means that the consumption of coffee, fatty meat, canned goods, smoked meats, muffins, and salt should be limited.

The nature of cooking matters. With exacerbation, you can not eat fried foods, it is better to switch to boiled or stewed. In general, the diet for vasculitis should be based on the form of the disease and the individual characteristics of the body, so when compiling a diet, it is very important to listen to the opinions of the doctor.

Drug treatment

Medication for mild vasculitis takes 2-3 months, with moderate - up to 6 months, in severe forms up to 12 months. In case of chronic recurrent vasculitis, treatment is carried out in courses of 4-6 months.

Drug groupThe mechanism of therapeutic actionRepresentativesMode of application
In most cases, their reception is ineffective. They are prescribed only to children at the very beginning of the disease in the presence of food and drug allergies.TavegilAt 0.001 g 2 times a day. The duration of treatment is up to 10 days.
Suprastin1 tablet 25 mg 3-4 times a day for 7-10 days.
Nonsteroidal anti-inflammatory drugsThey have a pronounced anti-inflammatory effect, effectively relieve joint pain, reduce swelling and severity of skin rashes.PiroxicamAssign 1-2 tablets or capsules once a day, after meals.
Ortofen1-2 tablets (25-50 mg) inside 2-3 times a day.

Duration of administration is 4-6 weeks. Do not take with aspirin.

Antiplatelet agentsReduce blood coagulability and prevent blood clots, inhibiting platelet adhesion. Recommended for all forms of the disease.Chimes25-50 mg 3-4 times a day for 3-10 weeks.
Aspirin1 tablet 3-4 times a day. Appointed for a period of 3 weeks to 6 months.

Take after meals.

AnticoagulantsSlow down blood coagulation, the conversion of fibrinogen to fibrin and the formation of blood clots.HeparinThe dose is selected individually, so that the activated partial thromboplastin time (determined by a coagulogram) increases by 2 times.
CorticosteroidsThey have an immunosuppressive effect, reducing the attack of antibodies. They have a pronounced anti-inflammatory effect. Be sure to be prescribed for severe vasculitis.PrednisoneThe daily dose of 2 mg / kg.
Cytostatics (immunosuppressants)Assign according to indications: with the ineffectiveness of treatment with corticosteroids or the presence of contraindications to them, as well as the rapid progression of the disease. They suppress cellular immunity reactions and reduce antibody production.AzathioprineThe drug is prescribed in a dosage of 2-4 mg / kg. The duration of therapy is from 6 months. up to 2 years.
CyclophosphamideAt the rate of 100-200 mg / m 2 2-3 times a week for 3-4 weeks.
EnterosorbentsBind toxins and biologically active metabolic products in the intestinal lumen. They are prescribed for all forms of vasculitis.Thioverol1 teaspoon 2 times a day. Depending on the form of the disease, from 2 weeks to 3 months.
Nutriclins1-2 capsules 2 times a day.

Non-drug therapy

Type of procedureOperating principleTreatment result
HemosorptionBlood is cleaned of toxins by contact with the sorbent. A catheter is inserted into the peripheral vein, through which blood is taken and passed through an apparatus that ensures its contact with the sorbent, and then returned to the venous bed.The sorbent binds toxins and purifies the blood. Due to this, blood circulation and microcirculation are stimulated, tissue nutrition improves.
ImmunosorptionVenous blood is passed through an apparatus filled with immunosorbent.Immunosorbent is a specially selected drug that binds certain substances and molecules - immune complexes and antibodies that cause vascular damage.
The method of purification of blood plasma. Centrifuge plasmapheresis - blood is taken from the peripheral vein. Using a centrifuge, it is divided into blood cells and plasma. Next, red blood cells are returned back to the bloodstream with plasma-replacing solutions or donor plasma. At membrane plasmapheresis plasma is cleaned through a special membrane and immediately returns to the bloodstream.Removal of immune complexes, antibodies and antigens from the blood that cause the development of vasculitis.

Doctors of various specialties are involved in the treatment of vasculitis: dermatologist, infectious disease specialist, rheumatologist.

Complications

The deterioration of the blood supply to the tissues around the affected vessels leads to severe damage to the internal organs. Without timely and competent treatment, the consequences of vasculitis can lead to severe disability.

  1. Perforation of the stomach or intestines - a rupture of the intestinal wall and the exit of its contents into the abdominal cavity. It is the most common complication of the abdominal form of hemorrhagic vasculitis. With vascular damage, the wall of the digestive tract does not receive proper nutrition, atrophies and becomes thinner. Rupture can occur as a result of a spasm or sprain of a food lump. A life-threatening complication of this condition is peritonitis - inflammation of the peritoneum.
  2. Chronic renal failure is a violation of all kidney functions. Damage to kidney tissue caused by circulatory disorders. Lack of oxygen and nutrients leads to mass death of kidney cells.
  3. Bleeding of internal organs - an outflow of blood into the lumen of internal organs or other natural cavities. The cause of internal bleeding is a rupture of the wall of large vessels or the destruction of infiltrates associated with necrosis. Various types of bleeding are characteristic of vasculitis: pulmonary, intestinal, uterine in women, hemorrhage in the testicle in men.
  4. Intestinal obstruction in patients with vasculitis is often associated with intestinal invagination. In this condition, one part enters the lumen of the other, clogging it and disrupting the movement of food masses.
  5. Hemorrhagic stroke - intracerebral hemorrhage associated with rupture of the vessel wall.
  6. The defeat of the heart. Malnutrition leads to depletion of the muscle fibers of the heart. They are stretched and deformed. In the complete absence of nutrition, cell death occurs. The most common complications from the side of the heart: myocardial infarction - death of a part of the heart muscle, rupture of aneurysm (protrusion of the wall) of the aorta, the formation of heart defects due to valve damage - stenosis and mitral and aortic valve insufficiency.

How and with what to treat vasculitis?

Treatment of vasculitis is carried out depending on the concomitant disease and affected organs. Primary allergic vasculitis often goes away on its own, without requiring special treatment. When the disease affects organs important for life (brain, heart, lungs, kidneys), the patient needs intensive and aggressive therapy.

If vasculitis has a severe course, then the person will be hospitalized. With a moderate illness, a person can receive therapy at home. Be sure to place in a hospital patients with an acute attack of vasculitis, pregnant women and children. The hospital also treats hemorrhagic vasculitis. When the disease worsens, the patient needs to observe bed rest. This allows you to quickly deal with the symptoms of vasculitis and stabilize blood circulation.

For the treatment of vasculitis, corticosteroids, chemotherapy in minimal doses are used.The aim of treatment is not only the restoration of the functions of the affected organs, but primarily the suppression of the abnormal reaction of the immune system, which destroys blood vessels and disrupts the normal blood supply to tissues.

Nutrition for vasculitis

Nutrition for vasculitis is based on the rejection of products that can enhance or cause allergies.

A hypoallergenic diet for vasculitis excludes:

  • salty and fried foods
  • mushrooms
  • honey and pollen
  • eggs
  • industrial canned food
  • coffee, chocolate,
  • strong tea,
  • alcoholic drinks
  • fruits and berries:
    • citrus fruits - oranges, tangerines, lemons,
    • strawberries, strawberries,
    • red apples
  • Butter baking
  • chips, crackers and other products containing flavorings, colorings and flavor enhancers,
  • individually intolerable products.

In case of kidney damage (nephritis), table No. 7 is recommended, with severe abdominal syndrome (gastrointestinal damage), table No. 4 is prescribed.

Non-drug treatment

Blood purification procedures can cope with the symptoms of the disease.

These are the so-called methods of gravitational blood surgery:

  1. Immunosorption. This procedure is aimed at cleansing venous blood. It is passed through special equipment in which the immunosorbent is located.
  2. Hemosorption. Blood is passed through a device that contains a special sorbent. It contributes to its purification from immune complexes, antibodies and antigens.
  3. Plasmapheresis. Blood is passed through a device that cleans it or replaces it with plasma.

Prevention of exacerbations of the disease in a child

  • Vaccinations are contraindicated in children with systemic vasculitis. Vaccines can cause an exacerbation of the disease.
  • Physical therapy classes. The set of exercises depends on the nature of the damage and is selected individually in the physical therapy rooms at clinics.
  • Compliance with the daily routine. Allow enough time to sleep and rest and avoid overwork.
  • Sanatorium-resort treatment in sanatoria specializing in the treatment of diseases of the cardiovascular system and rheumatological diseases. Mineralnye Vody, Pyatigorsk, Saki, Yalta.
  • Prevention of frequent infections is based on gradual systematic hardening.
  • Full hypoallergenic nutrition.

Alternative methods of treatment of vasculitis

Alternative methods of treating vasculitis are based on reducing the immune attack and allergic reaction, as well as improving the properties of blood.

Herbal collection reduces the manifestations of allergies, has an anti-inflammatory effect, removes toxins and improves blood circulation. To prepare the collection, mix 3 tablespoons of each ingredient:

  • poplar buds
  • calendula flowers
  • elderberry inflorescences,
  • yarrow grass
  • a string of grass
  • horsetail,
  • mint leaves.

1 tablespoon of the mixture is brewed with 200 ml of boiling water and insisted for 1 hour. Filter the infusion and take 100 ml every 3 hours on an empty stomach.

Licorice root contains substances similar to glucocorticosteroids, which eliminate the manifestations of allergies and have a powerful anti-inflammatory effect. You can use the finished syrup, using according to the instructions, or prepare the infusion yourself. To do this, a tablespoon of licorice roots is brewed with 200 ml of boiling water and heated in a water bath for 20 minutes. Filter the broth and take 2 tbsp. 30 minutes before meals 4 times a day.

Medical leeches - leech saliva contains biologically active substances hirudin and viburnum, which reduce blood coagulation and prevent blood clots. Bdellins and aeglins reduce the activity of enzymes that cause inflammation. A reflex reaction to a leech bite leads to increased blood formation and improved blood properties. Leech set on the affected area. The duration of the session is 40-60 minutes. For the treatment of vasculitis, 8-10 sessions are required.

You should not treat vasculitis yourself with folk remedies.Contact a rheumatologist, he will recommend you a means proven in practice. Uncontrolled intake of infusions of medicinal herbs can increase allergies and cause the appearance of new rashes.

The consequences of vasculitis

The deterioration of the blood supply to the tissues around the affected vessels leads to severe damage to the internal organs. Without timely and competent treatment, the consequences of vasculitis can lead to severe disability.

  • Chronic renal failure is a violation of all kidney functions. Damage to kidney tissue caused by circulatory disorders. Lack of oxygen and nutrients leads to mass death of kidney cells.
  • Perforation of the stomach or intestines - a rupture of the intestinal wall and the exit of its contents into the abdominal cavity. It is the most common complication of the abdominal form of hemorrhagic vasculitis. With vascular damage, the wall of the digestive tract does not receive proper nutrition, atrophies and becomes thinner. Rupture can occur as a result of a spasm or sprain of a food lump. A life-threatening complication of this condition is peritonitis - inflammation of the peritoneum.
  • Intestinal obstruction in patients with vasculitis is often associated with intestinal invagination. In this condition, one part enters the lumen of the other, clogging it and disrupting the movement of food masses.
  • Bleeding of internal organs - an outflow of blood into the lumen of internal organs or other natural cavities. The cause of internal bleeding is a rupture of the wall of large vessels or the destruction of infiltrates associated with necrosis. Various types of bleeding are characteristic of vasculitis: pulmonary, intestinal, uterine in women, hemorrhage in the testicle in men.
  • The defeat of the heart. Malnutrition leads to depletion of the muscle fibers of the heart. They are stretched and deformed. In the complete absence of nutrition, cell death occurs. The most common heart complications:
    • myocardial infarction - death of a section of the heart muscle,
    • rupture of aneurysm (protrusion of the wall) of the aorta,
    • the formation of heart defects due to valve damage - stenosis and insufficiency of the mitral and aortic valves.
  • Hemorrhagic stroke - intracerebral hemorrhage associated with rupture of the vessel wall.

Forecast

The prognosis for vasculitis depends on the form of the disease and on how quickly treatment is started. So, with early therapy with cytostatics in combination with glucocorticosteroids, the five-year survival rate of patients with vasculitis reaches 90%. This means that 9 out of 10 patients live longer than 5 years. Without timely treatment, five-year survival is 5%.

The forecast worsens in the following cases:

  • the onset of the disease after 50 years,
  • kidney damage
  • damage to the gastrointestinal tract,
  • damage to the central nervous system,
  • damage to the aorta and blood vessels of the heart.

This means that people with similar conditions need to be attentive to their health and strictly follow the treatment regimen. In this case, it is possible to avoid the development of severe complications.

Prevention of vasculitis

Effective prevention of vasculitis has not yet been developed. There are general recommendations aimed at preventing immunity disorders and allergies, which are considered triggering factors of the disease.

Preventive measures for the appearance or exacerbation of vasculitis:

  • Remediation of foci of infection - treatment of carious teeth, chronic tonsillitis, adnexitis,
  • Restricted sun exposure,
  • Exclusion of contact with allergens,
  • Elimination of stress and hypothermia,
  • Dosed physical activity,
  • Rational use of drugs
  • Healthy food based on organic products.

Description

Vasculitis (lat. Vasculum - vessel, -itis - suffix denoting inflammation) means "inflammation of the blood vessels." a disease in medical terminology is also known as arteritis and angiitis.

Inflammation is the natural response of the immune system to traumatic tissue damage or the introduction of infectious agents. Such a protective reaction is characterized by local tissue edema, which sometimes can help the body cope with the invasion of microbes.

With vasculitis, for some reason, the immune system attacks healthy blood vessels, causing them to swell and break down. This can be caused by an infection or medication, although often the cause is not conclusively established.

Vasculitis can range from a minor problem that affects only the skin, to more serious diseases that can cause problems with vital organs like the heart or kidneys.

The main division of vasculitis is into primary and secondary.

  • Primary vasculitis arise due to an inflammatory process that directly affects the vessels themselves.
  • Secondary vasculitisaccompanied by inflammatory vascular lesions on the background of another (main) disease.

Primary systemic vasculitis is also distinguished - an autoimmune disease that occurs without any known cause, although a genetic predisposition may make some people more susceptible.

Types of Vasculitis

There are many types of vasculitis, among which it is often found eosinophilic granulomatosis with polyangiitis. The disease, also called Churg-Strauss Syndrome, is a type of vasculitis that primarily affects adults between the ages of 30 and 45.

Against the background of vascular damage, abnormally eosinophils may occur:

  • asthma,
  • allergic rhinitis (cold-like symptoms caused by allergies),
  • high fever (fever)
  • muscle and joint pain
  • fatigue,
  • loss of appetite and weight loss.

Vasculitis can also affect nerve fibers, causing weakness, tingling, or numbness. In severe cases, it damages the kidneys or heart muscle.

Usually, pathology is treated with steroid drugs.

Giant cell arteritis is a type of vasculitis that often affects arteries in the head and neck. It is mainly determined in adults older than 50 years.
Pathology is sometimes called temporary arteritis.

In severe cases, the disease can cause:

  • pain and soreness in the neck and head,
  • muscle pain in the jaw while eating,
  • double vision or loss of vision,

Pathology is also usually found along with rheumatic polymyalgia, when various muscles begin to hurt.

The main treatment is steroid drugs.

Granulomatosis with polyangitisAlso called Wegener's granulomatosis, it is a type of vasculitis that mainly affects the blood vessels in the nose, paranasal sinuses, ears, lungs and kidneys. The disease is most often determined in middle-aged or elderly people.

In the absence of timely treatment, the course of the disease can complicate:

  • high fever (fever)
  • night sweats
  • sinus inflammation (sinusitis),
  • nosebleeds and a crust in the nose,
  • shortness of breath and coughing up blood
  • kidney problems.

This serious disease can be fatal, as it often leads to organ failure. This type of vasculitis is usually treated with steroid drugs or other drugs that reduce the activity of the immune system.

Purple Schönlein-Genoch - This is a rare type of vasculitis that is commonly found in children and can affect the skin, kidneys or intestines. It is believed that the pathology is caused by the body's response to the infection.

In advanced cases, it can cause:

  • a rash that looks like small bruises or reddish-purple spots,
  • joint pain
  • stomach ache,
  • diarrhea and vomiting
  • blood in urine or feces.

It usually proceeds without serious consequences and tends to improve without treatment.

Kawasaki disease - A rare disease that can occur in children under the age of five.The main reason is considered infection, although it is not always possible to reliably determine.

The main manifestations:

  • fever (fever) that lasts more than five days,
  • rashes,
  • swollen glands in the neck,
  • red fingers or toes,
  • Red eyes,
  • redness of the lips, tongue, or mouth.

Kawasaki disease can affect the coronary arteries, the blood vessels that supply blood to the heart, so some children have problems with the work of this organ.

Usually, the disease should be treated in a hospital with aspirin and special immunoglobulin therapy.

Microscopic polyangiitis - A rare and potentially serious long-term type of vasculitis that most often develops in middle-aged people. It can affect any organ, but especially affects the lungs, kidneys and nerve fibers.

The main manifestations:

  • rash
  • shortness of breath and coughing up blood,
  • red and sick-looking eyes,
  • tingling or numbness
  • kidney problems.

This type of vasculitis is usually treated with steroid drugs or other drugs that reduce the activity of the immune system.

Nomatosis of polyarteritis - This is a rare type of vasculitis, which especially affects the arteries that feed the intestines, kidneys and nerves. It tends to develop in childhood or in middle-aged people. It can sometimes be caused by an infection such as hepatitis B, but the exact cause is unclear.

The main manifestations:

  • muscle and joint pain
  • pain in the abdomen (abdominal cavity), especially after eating,
  • rash,
  • tingling sensation or numbness,
  • bleeding and ulcers in the intestines.

Pathology can be very serious if there is no treatment.

Therapy is based on steroid drugs, and sometimes other drugs that reduce the activity of the immune system.

Directions of treatment for vasculitis

  • Vascular plastic surgery

Treating narrowed, scarred, or “dangling” blood vessels involves the expansion of one or more narrowed arteries so that blood can flow more easily through the organ or limb that it nourishes. A stent may also be part of angioplasty. In this case, a narrow metal tube is inserted into the blood vessel at the site of narrowing and straightens, which helps to open the blood vessel and prevent repeated narrowing.

In order to dilute the blood, anticoagulants are prescribed. With their help, the risk of thrombosis and clogging of blood vessels is reduced.

Patients taking anticoagulants, such as warfarin, need to remember the importance of periodically checking blood coagulation. This will avoid complications in the form of unforeseen bleeding.

Based on the use of drugs that allow you to control blood pressure. It is necessary if the patient has hypertension. In general, blood pressure should be monitored in all cases of vasculitis. The occurrence of hypertension with vasculitis can lead to damage to the kidneys.

When the kidneys do not work properly and eliminate toxins from the body, acids and fluid accumulate. The dialysis process helps cleanse the blood and support patients with severe renal failure. Sometimes this treatment is carried out temporarily (after a few days, weeks or months), which allows the kidneys to recover in the presence of reversible damage. If kidney damage is not reversible, dialysis treatment is performed continuously. For patients in need of long-term dialysis, the procedure is done at home or on an outpatient basis.

  • Plasma exchange or plasmapheresis

This treatment is sometimes used in patients with severe vasculitis when antibodies are thought to play an important role in causing the disease. Treatment involves removing antibodies from the blood using equipment and returning the “purified” blood back to the patient’s bloodstream.This may require the transfer of blood products to the patient, including plasma, albumin or immunoglobulin. Medications can also be used to clean the blood and prevent it from clotting in the machine.

Patients with vasculitis, especially those immunocompromised, should not receive live vaccines. If you take drugs against influenza and pneumonia, then they are not live vaccines, therefore, they are recommended for use by patients with vasculitis.

Video: Vasculitis - treatment of vascular disease

Autoimmune

The first is relatively rare, at least in a pure, isolated form.

The bottom line is to increase the body's sensitivity to external stimuli, up to the effect of a small amount of allergen, bacterial toxin.

Immunity takes the cells of the endothelium, the inner lining of the vessel, for dangerous substances and initiates the production of antibodies that destroy tissues.

Perhaps the beginning of the process without a trigger factor, spontaneous. From the point of view of cure, this mechanism of development of vasculitis is complex, the use of immunosuppressants and a group of supporting, anti-inflammatory drugs are required.

Infectious

Plays an important role. Basically, it causes secondary forms of vasculitis. Moreover, the focus is always located outside the vessel.

This can be a sore throat, tuberculosis, localized in the lungs or excretory system, transferred syphilis without treatment, sexually transmitted infections, and many other options.

Any focus is considered as a potential source of damage.

Mixed forms

According to specialized studies, it is they in the vast majority of cases that are found.

This happens according to a complex scheme: at the initial stage, infectious agents, the more so for a long time existing in the body, penetrate the structure of blood vessels, but are not activated. Because there are no symptoms of vasculitis.

However, it is they, their metabolic products, that elicit an immune response. At a certain point, the defenses fail and do not work as they should.

Vasculitis further develops according to a destructive scenario: there is inflammation of the vascular wall.

Both large structures and smaller arterioles, veins, capillaries suffer. Not always together. Isolated forms are possible when one vessel or its fragment is involved.

As a result of inflammation and swelling, a narrowing of the lumen, the diameter of the hollow structure occurs, the blood flow weakens. Acute ischemia of tissues that feed on the affected vessel begins. Fatal outcomes are likely.

With timely treatment, there is a chance to reduce all complications to nothing, but in most cases there is a trace of the disease. In the form of fibrin strands - adhesions in the vessel or scarring of the walls, the growth of connective tissue, which acts as a natural mechanical obstacle.

In both cases, it is a circulatory disturbance, chronic. Therefore, a high risk of disability or death is created, depending on which vessel is affected.

General information

Vasculitis (a synonym for this name is the term angiitis) Is the name for a heterogeneous group of diseases, the basis of which is the immunopathological inflammatory process affecting the vessels. It affects various vessels - arteries, arterioles, veins, venules, capillaries. The consequence of this disease is changes in the functions and structure of the organs that the affected vessels supply with blood. A disease can cause bleeding, necrosis, ischemia.

Until now, scientists are conducting research, trying to more accurately determine vasculitis - what kind of disease and what causes it to develop. The exact causes of the disease are still not known. It is assumed that the disease develops due to the influence of external factors in combination with genetic location.There is also evidence that the disease can be caused by hepatitis B virus or Staphylococcus aureus. The code for ICD-10 is I77.6.

Treatment regimens for various degrees of severity of pathology

It is necessary to treat angiitis of varying severity according to different schemes. The first severity of the disease is characterized by vascular lesions and the appearance of superficial symptomatic pigmentation spots. The skin is affected in a limited way by small rashes, in which the temperature does not increase, there are no muscle and joint pains. A blood test with a first degree of damage gives normal values ​​except for the erythrocyte sedimentation rate, which is elevated.

For patients suffering from this type of disease, non-steroidal anti-inflammatory drugs are indicated, among which Nimesulide, Indomethacin, Meloxicam can be noted. Antibacterial drugs for treating the disease are Doxycycline, Ciprofloxacin, Azithromycin.

In order to destroy microbes, quinolines are shown - Chloroquine, Hydroxychloroquine, and Desloratadine, Levocetirizine, Fexofenadine are shown as antihistamines.

In the second severity of the pathology, the condition of the patients is characterized by a significant deterioration. The skin is no longer affected locally, but everywhere. Body temperature is higher than subfebrile, and a blood test gives a way out of the acceptable boundaries of most indicators. Patients suffer from weakness, pain in muscles and joints, neuropathy is observed. With this degree of disease, the treatment regimen is more complex, more drugs are prescribed from various groups.

Patients are prescribed systemic glucocorticoids - Betamethasone, Prednisolone, and proton pump inhibitors are used to reduce the harmful effects of these drugs on the body, among which omeprazole is important. As with mild cases, patients should take Nimesulide, Doxycycline, or Meloxicam. Antibacterial drugs for patients with severe vasculitis are Azithromycin, Ofloxacin, and Amoxicillin.

Antibiotics are essential in the treatment of vasculitis

Pentoxifylline, Anavenol, Diosmin, Hesperidin are indicated as angioprotectors. Among antihistamines, doctors recommend Cetirizine, Ebastin, Levocetirizine. To remove toxins, the drug Dextran is used.

Local treatment of vasculitis

External treatment of the skin surface in vasculitis is based on the use of ointments and creams to improve the condition of blood vessels. These include Troxevasin, Troxerutin, Iruksol, Solcoseryl. Useful applications of Dimexidum.

With the first degree of skin damage, it is enough to use ointments Betamethasone, Mometasone furoate, Methylprednisolone aceponate. The second degree of skin damage should be treated with such means as Levomekol, Solcoseryl, Dexamethasone, Actovegin. If wounds occur, vasculitis on the legs, arms and body is recommended with two percent silver sulfathiazole. Trypsin and Chymotrypsin lotions will be useful.

Additional techniques for the treatment of vasculitis

In addition to conservative medical measures, doctors try to help patients with vasculitis in various other ways. Recently, in the treatment of pathology, not only drugs have been used, but also additional treatment methods, such as plasmapheresis, UV irradiation of blood and hemoxigenation - oxygen saturation of the blood.

Extracorporeal hemocorrection provides positive results in the treatment of vasculitis. Thanks to this technique, it is possible to cleanse the blood of patients from various toxic substances and allergens that cause vasculitis. During hemosorption, the blood is purified using sorbents. For this, blood is taken from a vein and passed through filters in a special apparatus that contain sorbents. Thus, the blood is cleansed and returned to the bloodstream of the patient.After the procedure, the health of patients is significantly improved, blood circulation and nutrition of even the most distant tissue sites are stimulated.

With the help of hemosorption in patients, it is possible to achieve long-term remission

A variation of this therapy is immunosorption. The principle of the procedure is the same, but the blood is cleaned with an immunosorbent that removes its own antibodies and complexes from the blood, which provoke self-destruction of the vessel walls.

Using plasmapheresis, patients are cleansed by separation of plasma and blood. Blood cells return to the bloodstream with part of the donor plasma, and then their own purified plasma is introduced, passing through the membrane.

Dietary nutrition for vasculitis

It is important for patients suffering from vasculitis to limit their diet, in particular, to eliminate from the diet all foods that can cause inflammation or provoke a worsening of the patient's condition. Doctors pay special attention to nutrition correction - you need to eat in small portions six times a day so that the body has time to process the received products and remove the products of their decay. For this, the amount of fluid delivered per day should be at least two liters (if the kidneys are not affected). In order to improve the outflow of urine, salt intake is limited.

With vasculitis disease, patients are largely deprived of calcium reserves. To make up for it, fermented milk products with low and medium fat content will be useful. And in order not to provoke a potassium deficiency, it is necessary to eat dried fruits - raisins, prunes and dried apricots. These products can only be prohibited if the patient is diagnosed with renal failure.

Steamed dishes are recommended for consumption, especially vegetable, milk porridges, boiled low-fat fish and meat, eggs, berries and fruits in any form. Prohibited alcohol, coffee, strong tea, canned food, fried, sour and spicy foods.

Traditional medicine

Of course, vasculitis cannot be cured by folk remedies alone. This complex autoimmune disease requires treatment with a number of pharmaceuticals, but this does not mean that folk remedies cannot be used along with them. Before being treated with alternative methods, it is necessary to coordinate this with the doctor, perhaps the doctor will correct the treatment, or he will prescribe the necessary decoctions and infusions.

To improve blood coagulability, methods of herbs that contain enough vitamin K will help. Thanks to it, coagulation is better, there will be no subcutaneous hemorrhage. As a treatment, broths of dioica nettle, mountaineer, arnica flowers, shepherd's purse, yarrow, and St. John's wort are suitable. It is not necessary to be too zealous in taking these drugs and exceed the dose, because this can lead to thrombosis, clogging of vessels and aggravation of inflammatory processes, which is much worse for a patient with vasculitis.

In the treatment of vasculitis, vitamin K should not enter the body too much - patients should pay for the foods they eat

In order to remove the inflammatory process, you need to brew and make tinctures from knotweed, lingonberry, blackcurrant, elecampane, calendula, licorice root. To strengthen the walls of blood vessels, decoctions of aromatic root, cranberry, and currant are suitable. Useful green tea and rosehip tea, as well as compote from aronia. In the composition of salads for this purpose, you can add white cabbage. If vasculitis is allergic in nature, or is accompanied by an allergy, then in order to eliminate it, patients are recommended decoctions of oregano, lemon balm, St. John's wort, black elderberry, dioica nettle, motherwort, evading peony.

Skin manifestations of vasculitis can be eliminated using applications from infusions of plant herbs. Yarrow, mint, elderberry, and field horsetail will be useful.Cotton fabric is dipped in a decoction of plants and applied to the affected areas for at least half an hour. At night, you can impose birch buds, ground in flour, with nutria fat. A pound of fat is melted to a liquid state, a glass of dry rubbed kidneys is placed there, and so the mixture is mixed until smooth. Then the mixture is simmered in the oven over low heat for three hours for seven days. The resulting product can be used the next day, lubricating the surface of the skin at night under a bandage.

Treatment of vasculitis is an extremely complex and lengthy process. Not all patients manage to achieve stable remission, but already it can be considered a huge success in the treatment of the disease. This means that the body maximally compensated for its forces for the normal provision of vital processes and slowed down the destructive processes in the walls of blood vessels.

Pathogenesis

Work is still underway to study the etiology of systemic vasculitis. In particular, there is an opinion about the likely role of a bacterial or viral infection in its development. The pathogenesis of the disease is complex, including a number of immune mechanisms. It is assumed that such factors play a role in the development of systemic vasculitis:

  • The formation in the body of autoantibodies to antineutrophilic cytoplasmic antibodies, during which neutrophils are activated and adhere to endothelial cells, which leads to their damage.
  • Education autoantibodies to antigens vascular walls.
  • The formation of pathogenic immunocomplexes and their deposition into the vessel wall. Which affects polymorphonuclear leukocytes after complement activation. In turn, they produce lysosomal enzymes that damage the vascular wall. Its permeability increases. With immune inflammation of the vessel, it often manifests itself thrombosis.
  • Immune System ResponsesT lymphocytes. This mechanism is decisive in development. Wegener's granulomatosis. Due to the interaction with the antibody, sensitized T-lymphocytes produce lymphokines that inhibit macrophage migration. Then they concentrate them where antigens accumulate. Macrophages are activated and produce lysosomal enzymes, which leads to damage to the vascular walls. These mechanisms lead to the manifestation of granulomas.
  • The direct effect of a variety of infectious agents on the vascular wall.
  • Vasospastic and coagulation disorders.
  • Effects arising from the release of inflammatory mediators and cytokines.
  • Interaction processes white blood cells and endothelial cells, as a result of which a large number of re-formed and newly synthesized adhesive molecules are released.
  • Appearance antibodies to phospholipids. Such antibodies are found in patients with systemic vasculitis. Their cross-reaction with endothelial proteins is noted, which leads to an increase in the coagulating properties of blood.

Hemorrhagic vasculitis

This form is mainly benign. As a rule, a remission or recovery occurs in a few weeks. However, hemorrhoidal vasculitis can be complicated by damage to the intestines or kidneys. Most often, with this form of the disease, lesions of the skin develop. A hemorrhagic rash is palpable. purpura, which is poorly visible, but can be determined by touch. At the very beginning of the disease, vasculitis appears on the legs - the rash is localized in the distal parts of the lower extremities, and then passes to the hips, buttocks.

Also, with this form of the disease, articular syndrome is noted. Most often, large joints of the legs are affected. Migrating joint pains are noted at the time when skin rashes appear. Some patients may have abdominal syndrome, in which there is a defeat of the gastrointestinal tract.In this case, abdominal pain, nausea, vomiting, abdominal pain, and gastrointestinal bleeding are noted. Renal syndrome is also possible.

Cutaneous

With this kind of disease, small or medium vessels of the dermis are affected. However, the vessels of the internal organs are not affected. Symptoms of this kind of disease are similar to signs of a number of skin diseases. In particular, capillary outflows, damage to capillaries, nodules, hives. If this form accompanies systemic diseases, the patient is also worried about joint pain, fever.

Allergic vasculitis

With this form, the patient shows erythematous and hemorrhagic spots, rashes, nodules. Skin infarction is likely when a black crust forms in the rash. In places of rashes, burning pain or itching is manifested. Hemorrhages under the toenails are noted, muscles and joints hurt. The characteristic signs of the disease can be seen in the photo of allergic vasculitis.

Most often, with this form of vasculitis, a rash appears on the hips, feet, lower leg. If the ailment takes on a generalized form, rashes on the trunk and forearms may disturb.

This group includes acute and chronic erythema nodosum, Inductive erythema of Bazin, temporal angiitis, Behcet's disease.

The most important symptoms of Behcet's disease are relapsing stomatitis, genital ulcers. Behcet's syndrome also affects the mucous membrane of the eyes, the skin. The characteristic symptoms of this kind of disease are the formation of ulcers and erosion.

In patients with acute erythema nodosum, large nodes appear, and the color of the skin under them changes from red to greenish.

Systemic vasculitis

Speaking about systemic vasculitis - what kind of disease is it, it should be noted that this form of the disease develops in the event of a violation of the immune mechanisms in people with a variety of systemic diseases with lesions of the connective tissue.

With the development of Wegener's granulomatosis, the disease is manifested by the following symptoms: destructive changes in the respiratory tract, vessel walls and kidneys develop, ulcerated granulomas appear on the mucous membranes of the mouth, nose, bronchi, and develops glomerulonephritis. The disease leads to severe complications - internal organs, nervous system, organs of vision, skin suffer.

Autoimmune vasculitis with rheumatismextends to the body as a whole. Its manifestations depend on the stage of development. Autoimmune type of the disease affects the skin, blood vessels of the internal organs and the brain. The likelihood of internal bleeding increases.

Cryoglobulinemic vasculitis

This is a variation of the systemic form of the disease, which is characterized by the appearance of proteins in blood cells cryoglobulins. They are deposited on the walls of blood vessels and gradually destroy them. A characteristic feature of this disease, which has a progressive form, is damage to the peripheral nerves and a gradual loss of sensitivity. If you do not start treatment in a timely manner, this disease can provoke a motor paralysis and speech loss.

Urticarial vasculitis

This type of disease is one of the varieties of the allergic form in which chronic inflammation of the surface vessels of the skin develops. At the very beginning, such patients are often diagnosed with chronic urticaria. The disease proceeds in waves. A person develops hemorrhagic nodules, blisters, spots on the skin. He often feels a burning sensation in those places that were hit. The temperature rises, pain in the lower back, joints, muscles, abdomen, headache bothers. The temperature rises, glomerulonephritis develops.

General symptoms and photos of pathology

External manifestations of vasculitis, regardless of location, is a rash. It may be different, a single option does not exist.

Among the possible types are:

  • Pink spots.Small in diameter, maximum 0.5 cm., Multiple at the lesion site. Do not manifest themselves in any way.

  • Hemorrhagic rashes. They look like saturated red or purple and irregularly shaped spots. Falsely mistaken for bruises, look similar.

  • Infiltrates. Located under the skin. Palpated as soft formations, painless.
  • Hives. Itchy pink rash. Small spots that soon merge into a single focus and cause a lot of discomfort to the patient (see photo).

  • Erosion. Crater-like areas of tissue ulceration, as in combs after chickenpox.
  • Papules. Filled with serous exudate (clear fluid) vesicles. Size not more than 5 mm.

The second group of general points - signs of intoxication of the body:

  • Headache. Of different intensity. The more severe the disease, the more active the symptom.
  • Nausea.
  • Increased sweating, chilliness.
  • The increase in body temperature to marks from 37.5 to 40 degrees. The spread is large, which is due to various possible forms of the pathological process.
  • Drowsiness, weakness, asthenic manifestations (insufficient amount of strength to work, to perform duties in everyday life).
  • Refusal of food.
  • Dyspnea.

Takayasu disease (nonspecific aortoarteritis)

Arteritis Takayasu is a progressive granulomatous inflammatory process of the aorta and its main branches. Nonspecific aortoarteritis (Takayasu's disease) mainly affects women at a young age. About half of the patients who develop arteritis suffer from primary somatic symptoms. They develop a fever insomniafatigue, weight loss, joint pain. Often non-specific aortoarteritis leads to the development of anemia and increased ESR.

In about half of the patients, preliminary somatic symptoms do not develop, and only late changes in the vascular system are noted. In the process of the development of the disease in its later stages, due to the weakness of the walls of the vessels, localized aneurysms can develop. The disease also provokes development Raynaud's phenomenon. Therefore, it is important that treatment is started as early as possible, and the treatment protocol for patients with Takayasu's disease is clearly adhered to.

Wegener Granulomatosis

With this form, pain appears in the paranasal sinuses, ulcers on the nasal mucosa, ulcerative necrotic rhinitis. Destruction of the nasal septum can occur, which leads to saddle deformation of the nose. Other serious violations are also highly likely: developing rapidly renal failurecelebrated dyspneacoughing up blood.

Cherge-Strauss Syndrome

This disease is also called eosinophilic granulomatosis with angiopathy. In the process of its development, blood vessels are affected, as a result of which the process of supplying blood to vital organs worsens. The most common symptom of vasculitis by Charg-Strauss is asthma. However, besides her, other symptoms also appear: fever, rash, bleeding in the digestive tract, pain in the feet and hands. Sometimes the symptoms are mild, in other cases, severe signs that are life-threatening develop.

Polymorphic Dermal Angiitis

This is angiitis, in which chronic recurrent dermatosis develops due to a nonspecific inflammatory process in the walls of the vessels of the skin. In the process of the development of the disease, the skin of the lower legs is mainly affected. But rashes can appear in other places. Sometimes their appearance is preceded by general symptoms - fever, weakness, headache. Rashes do not go away for several months. After recovery, there is a risk of relapse. There are many varieties of this disease, depending on the characteristics of the rash.

Livedo angiitis

It mainly develops in women during puberty. Initially, persistent blue-cyanotic spots on the legs appear. Less commonly, they appear in other places.Spots can have different sizes and shapes. When cooled, the severity increases. Over time, small ulcers, necrosis, hemorrhages can develop on the spots. Patients are worried about chilliness, leg pain, soreness in ulcers.

Cerebral vasculitis

A serious disease, which is characterized by the development of the inflammatory process of the walls of the vessels of the brain. The cerebral appearance of this disease can trigger hemorrhages, tissue necrosis. In the process of developing the disease, the patient may be disturbed by a severe headache. Possible epileptic paroxysm, focal neurological deficit. In the process of the development of the disease, a manifestation of one of the sets of symptoms is likely:

  • multi-focal manifestations resembling a clinic of diffuse sclerosis,
  • acute encephalopathy with mental disorders,
  • symptoms characteristic of volumetric brain formation.

Microscopic vasculitis

This form mainly affects small vessels. It is rare, can begin as a pulmonary-renal syndrome, to which a rapidly progressing glomerulonephritis and alveolar hemorrhages. At the very beginning of the disease, general manifestations develop: fever, myalgia, arthralgia, weight loss. Other symptoms depend on which organs and systems are affected. Most often, kidney damage occurs, less often - the skin, respiratory system, gastrointestinal tract.

Tests and diagnostics

In the process of diagnosis, the following studies are carried out:

  • Blood and urine tests - they are performed repeatedly. In the process of such studies in patients with vasculitis, the acceleration of ESR, an increase in fibrinogen, an increase in C-reactive protein. Leukocytosis can be determined. Blood and urine tests help determine kidney damage.
  • Immunogram study. In the process of immunological research, for some forms of vasculitis, antineutrophilic cytoplasmic antibodies (ANCA) are determined. This greatly simplifies the diagnosis.
  • Allergological testing.
  • Instrumental methods of research - ultrasound, radiography, echocardiography, etc.
  • Biopsy the affected organ or tissue for immunohistochemical and histological examination. Such a study helps confirm the diagnosis.

But the determination of ANCA in blood serum by the method of indirect immunofluorescence or by enzyme-linked immunosorbent assay is nevertheless most important in the diagnostic process.

The set of studies that the doctor prescribes depends on the clinical picture, complaints of the patient.

Doctors often encounter difficulties at the stage of early diagnosis, as the symptoms of the disease are often mild, and are also similar to signs of other diseases. Therefore, differential diagnosis often causes certain difficulties. For example, with hemorrhagic vasculitis, an abdominal syndrome sometimes manifests itself, which can be perceived as a gastrointestinal disease requiring surgical intervention.

To correctly establish the diagnosis, the following algorithm is practiced:

  • Definition of clinical signs of vasculitis.With vascular damage, skin syndrome, trophic disorders syndrome, ischemic syndrome develop, mucous membranes involvement, arterial hypertension, vein involvement and organ changes are noted.
  • Determination of laboratory and clinical signs of the disease. The presence of common symptoms, laboratory indicators is assessed.
  • Differentiation of the primary and secondary nature of the disease.
  • Instrumental examination of blood vessels. To confirm vascular damage, Dopplerography, angiography, biomicroscopy, angioscanning, capillaroscopy are performed and the presence of characteristic signs of the lesion is assessed.
  • Identification of specific markers of vascular wall lesions, laboratory diagnosis of vasculitis.
  • Morphological examination of the material, the sampling of which was carried out by biopsy. For this, histochemical and immunomorphological methods are used.
  • Determination of the main pathogenetic links of vascular damage. At this stage, the type of disease is determined (vasculitis associated with immune complexes associated with ANCA, organ-specific antibodies, cell-mediated vasculitis with the formation of granulomas).
  • Determination of the probable etiology of the disease. In most cases, the etiology of primary vasculitis is unknown, but exposure to certain viruses and bacteria is not ruled out. Immunogenetic markers are detected.
  • Clarification of the form of vasculitis using classification criteria.

Medication

In the process of treating vasculitis, patients are prescribed taking such medications:

  • Glucocorticosteroids - the use of these drugs can achieve long-term remission. As a rule, patients are prescribed drugs prednisone. A drug Metipredused for basic treatment.
  • In severe forms of the disease, combined treatment with glucocorticosteroids and cytostatics is used (Cyclophosphamide) This drug is administered intravenously in high doses. The treatment is usually long.
  • Non-steroidal anti-inflammatory drugs are also used - Ibuprofen, Indomethacin.
  • If necessary, the doctor prescribes drugs from other groups - antimicrobial (Trimethoprim/Sulfamethoxazole), antiviral (Interferon, Vidarabine), antiplatelet agents, anticoagulants (Heparin, Warfarin), vasodilators, ACE inhibitor.
  • Patients with glomerulonephritis are prescribed intravenous immunoglobulin.
  • If severe kidney damage is noted, plasmapheresis is sometimes prescribed.
  • Treatment of hemorrhagic vasculitis in children involves the use of antibiotics.
  • Means are also prescribed that strengthen the vessels, reducing their fragility and permeability (vitamin C, routine)
  • If necessary, the following agents are also prescribed: antitumor (Rituximab), immunosuppressants (Azathioprine, Leflunomide, Mofetila mycophenolate).
  • It is possible to use drugs that dilate blood vessels and activate microcirculation (Pentoxifylline).
  • Prescribe medications that prevent the development of blood clots (acetylsalicylic acid).
  • To speed up the healing process of the rash on the legs, use local remedies: Ethacridine, Solcoseryl, Iruxol(for ulcers) Dimexide (for applications in places of inflammation).

Procedures and operations

With some forms of vasculitis, as well as with the development of thrombosis of large arteries, stenosis of the main arteries, surgical treatment is necessary.

With the development of chronic kidney failure in severe form, practice hemodialysis or spend transplantation the kidneys.

When acute symptoms can be eliminated, rehabilitation therapy is carried out using physiotherapy exercises and psychotherapy.

Hypoallergenic diet

  • Efficiency: therapeutic effect after 21-40 days
  • Dates: constantly
  • Product Cost: 1300-1400 rub. in Week

During the period of the disease, it is important to exclude from the diet all foods that can provoke allergic manifestations. It is necessary to completely remove chocolate, cocoa, eggs, citrus fruits from the diet. In renal failure, you should not eat too salty foods, as well as foods containing a lot of potassium. Alcohol should be completely excluded; do not eat too cold and too hot dishes.

It is important to adhere to the following recommendations:

  • Eat in small portions and at least 6 times a day.
  • Introduce foods containing vitamins C, B, K, and A.
  • The amount of salt per day should not exceed 8 g.
  • It is important to eat a lot of fermented milk products to restore the body's calcium reserves.
  • The menu should include vegetable soups, boiled vegetables, cereals with milk and regular, vegetable oils, sweet fruits, boiled meat and fish, crackers from white bread.
  • You need to drink green tea, herbal decoctions, jelly and stewed fruit.
  • As you recover, the diet is adjusted.

Consequences and Complications

If the disease is not treated on time, the following complications may occur:

  • liver and kidney failure,
  • abscessesabdominal cavity
  • pulmonary hemorrhage
  • intestinal invagination,
  • polyneuropathy.

If during the development of the disease a part of the blood vessel is elongated and dilated, the risk of aneurysms.

If the vessels narrow in the course of the inflammatory process, the blood supply to certain organs and tissues may stop, which increases the likelihood of necrosis.

List of sources

  • Dunaeva N.V., Nikitina O.E., Stukov B.V., Karev V.E., Masing A.V., Lerner M.Yu., Lapin S.V., Totolyan A. Cryoglobulinemic vasculitis associated with chronic hepatitis B: clinical observations and literature review.
  • Nasonov E.L., Baranov A.A., Shilkina N.P. Hemorrhagic vasculitis (Schoenlein-Genoch disease) // Vasculitis and vasculopathy. - Yaroslavl: Upper Volga, 1999 .-- 616 p.
  • Handbook of a practitioner. Under. ed. Vorobyev A. I. "Medicine", 1981.
  • Shostak N.A., Klimenko A.A. Systemic vasculitis: new in classification, diagnosis and treatment. Clinician. 2015.9 (2): 8-12
  • Shilkina N.P., Dryazhenkova I.V. Systemic vasculitis and atherosclerosis. Ter. Arch. 2007, 3: 84-92.

Education: She graduated from the Rivne State Basic Medical College with a degree in Pharmacy. She graduated from Vinnitsa State Medical University. M.I. Pirogov and an internship based on it.

Experience: From 2003 to 2013, she worked as a pharmacist and manager of a pharmacy kiosk. She was awarded letters and distinctions for many years of conscientious work. Articles on medical topics were published in local publications (newspapers) and on various Internet portals.

The defeat of the vessels that feed the digestive tract

The standard symptoms of vasculitis localization in the gastrointestinal structures are presented by the clinic of the acute abdomen:

  • Severe abdominal pain. Spilled, cutting, or burning. Shooting.
  • Frequent stool, diarrhea with water interspersed with red fresh blood.
  • Nausea, vomiting.
  • Impairment of consciousness, pallor of the skin, cyanosis of the nasolabial triangle, growth, and then a rapid drop in blood pressure and heart rate, drowsiness.
  • Collapoid state. Talks about a critical scenario for the development of a pathological process.
Attention:

Possible intestinal rupture. If you do not conduct timely treatment. In this case, peritonitis will begin.

Retinal vessels affection

Accompanied by a decrease in visual acuity. Fog in sight.

Monocular blindness is possible (on the one hand). When the vessel ruptures, floating reddish spots occur.

A large volume of blood output is accompanied by detachment of the retina. Without medical assistance, the process ends with a complete loss of vision.

Central nervous system malnutrition

Brain symptoms are considered one of the most dangerous in terms of the prospects of death.

  • Headache. Expressed. Shooting, baling.
  • Nausea, vomiting.
  • Impaired consciousness.
  • Decreased sensitivity of the body, limbs.
  • Fainting.
  • Inhibition, weakness, drowsiness. Inability to perform even the simplest daily activities.

Neurological focal manifestations: paralysis, paresis, dizziness, unsteady gait, visual dysfunctions, hearing loss, smell, touch, mental activity and other options.

Heart disorders

Manifestations resemble those of angina pectoris. Accordingly, the process is accompanied by discomfort of a burning or pressing character in the chest, arrhythmia, impaired consciousness, shortness of breath.

Among all species, neurovasculitis (affecting the brain), as well as the cardiac form, are considered the most lethal.

Destruction of the abdominal vessels leads to death twice less. Involvement of limbs rarely ends fatally, the main consequence is gangrene and amputation.

Autoimmune forms are accompanied by less active symptoms, as a rule. But this is not always the case. Infectious types are more aggressive and worse in terms of prognosis.

Therapy

Treatment of vasculitis involves the use of a conservative or surgical technique. The first resort more often.

It is advisable to hospitalize a person in a hospital for thorough comprehensive treatment. The more intense the symptoms of vasculitis, the more active the therapy.

Among the prescribed medications:

  • Anti-inflammatory non-steroidal origin. Stop the process of release of special substances-mediators, relieve pain, swelling. They act comprehensively, but are categorically not suitable for long-term use. Dangerous side effects are likely. Ketorolac, Nise, Ibuprofen and others.
  • Glucocorticoid preparations. They have a more powerful anti-inflammatory potential and are used in high doses for the defeat of large vessels (for example, aorta). Systemically affect the whole body, but also do not apply for a long time. Dangerous side effects are likely. Dexamethasone, Prednisone.
  • Anticoagulants. Thin the blood. Aspirin, Heparin.
  • Sorbents. Bind harmful toxic substances and contribute to their natural elimination. Thioverol and others will do.
  • Cytostatics. In extreme cases, if autoimmune vasculitis occurs. To eliminate an acute condition.

Surgical treatment is required in a limited number of situations. Mainly against the background of total scarring of a large vessel, the formation of a large number of fibrin strands (adhesions).

Then their excision or prosthetics of the affected area is performed. Moreover, depending on the cause of the disease, a systematic drug treatment is also required.

Finally

Vasculitis is a whole group of diseases of the vascular inflammatory plan. It carries a huge danger to health and life. Often ends with disability and death of patients.

You can not hesitate in passing the diagnosis and conducting therapy in an inpatient setting.

At the first signs, even remotely resembling those with vascular inflammation, you need to urgently consult a doctor (first to a surgeon) or call an ambulance.

Watch the video: Treatment for Varicose Veins. Nucleus Health (March 2020).