Vasculitis on the hands symptoms. Hemorrhagic vasculitis: photos, causes and methods of treatment in children and adults

As a result of inflammation of the walls of dermal vessels and their saturation with immune cells, skin vasculitis is formed. Their clinical manifestations are associated with damage to small and/or medium-sized cutaneous vessels. In half of the cases, the causes of the disease remain unknown; treatment depends on the severity of the inflammatory process.

Characteristics of the disease

Vasculitis is an inflammation of the blood vessels, which causes various symptoms of damage to the skin, and in some cases, internal organs. The walls of the arteries are saturated with immune cells - neutrophilic leukocytes, and undergo necrosis (death). At the same time, the permeability of the vascular wall increases, and hemorrhages occur around it.

The pathological process is often associated with the deposition on the inner surface of the arteries of circulating immune complexes, consisting of foreign substances that have entered the body (antigens) and protective antibodies. Such immune complexes, settling on the endothelium of the vessel, lead to its damage and inflammation. This development mechanism characterizes the most common form of pathology – allergic cutaneous vasculitis.

The disease can have varying degrees of severity - from minor damage to skin vessels to involvement of arteries in all internal organs with disruption of their function. Therefore, the assessment of systemic manifestations of the disease is of primary importance in treating patients.

Causes and types of pathology

Classification schemes are varied. They are based on various criteria, including the size of the affected vessels, microscopic appearance, external manifestations of the disease and its causes.

The following main types of cutaneous vasculitis are distinguished:

Polyarteritis nodosa

This is an inflammatory damage to medium and small arteries, accompanied by their necrosis, without damage to the kidneys, involvement of arterioles, small venous vessels, capillaries and the formation of glomerulonephritis.

Wegener's granulomatosis

Inflammatory process of the respiratory system with the formation of specific inflammatory nodules - granulomas, and vasculitis with necrosis of the vascular wall, affecting capillaries, small and medium-sized arteries and veins; Damage to the glomeruli of the kidneys often develops - nephritis.

Churg-Strauss syndrome

An inflammatory process with a predominance of an allergic component, affecting the respiratory system, accompanied by damage to small and medium-sized arteries, often associated with bronchial asthma.

Microscopic polyangiitis

Inflammation of a necrotizing nature with a slight immune-dependent component, often damaging capillaries, less often larger vessels; With this disease, necrotizing glomerulonephritis and lung damage are very often observed.

Henoch-Schönlein purpura

Pathology with deposition of immune complexes containing IgA class antibodies. The disease affects small vessels, including skin, kidney, intestinal, and causes pain or inflammation in the joints (cutaneous-articular vasculitis).

The process affects small vessels and is associated with the formation of special proteins in the blood - cryoglobulins; in this pathological process, the skin and kidney tissue are affected.

Cutaneous leukocytoclastic vasculitis (angiitis)

Limited inflammation of only the dermal vessels, without involvement of the kidneys and other organs.

Depending on the suspected cause of the disease, primary and secondary skin vasculitis are distinguished.

Since the etiological factors are varied, in clinical practice the most important classification is based on the size of the affected vessels. Signs of skin pathology appear when the smallest capillaries and medium-sized vessels are involved. Therefore, scientists divide all forms of vasculitis according to this criterion:

• predominant damage to capillary and smallest vessels: cutaneous leukoclastic, urticarial vasculitis and Henoch-Schönlein purpura;
• involvement of medium-sized arteries: polyarteritis nodosa;
• damage to both small and larger vessels: cryoglobulinemic variant, lesions in connective tissue diseases.

Manifestations of cutaneous vasculitis

External manifestations

The symptoms of cutaneous vasculitis are mainly determined by the diameter of the vessels involved in the process. When small vessels are involved, purpura occurs on the surface of the skin. Less commonly, a papular rash, urticaria, blisters, pinpoint petechiae, and erythema are formed.

With inflammation of medium-sized vessels, the following skin signs are observed:

• livedo reticularis;
• ulcerative-necrotic form of pathology;
• subcutaneous nodes;
• necrosis of the nail phalanges of the fingers.

Vasculitis with predominant damage to small vessels

Cutaneous leukocytoclastic angiitis

This is a diagnosis made by excluding other causes of pathology, accompanied by inflammation exclusively of the skin vessels. The onset of the disease is often associated with an acute infectious disease or the use of a new drug for the patient.

A typical sign is a limited lesion that goes away on its own after a few weeks or months. 10% develop a chronic or relapsing form of the disease. The damage looks like purpura, papules, vesicles, urticaria, and is located on areas of the skin exposed to friction.

Allergic (urticarial) vasculitis

This form occurs in 10% of patients with chronic. Differences between pathology and urticaria:

• the lesion persists for more than a day;
• in the clinic, it is not itching that predominates, but burning of the skin;
• the presence of purpura and darkening (hyperpigmentation) of the skin at the site of the lesion.

Most cases of the urticarial variant occur from an unknown cause, but others are caused by Sjögren's syndrome, lupus, serum sickness, hepatitis C, or malignancy. Also important is the long-term effect of harmful physical factors - solar radiation or cold air.

The urticarial variant is divided into 2 forms: with normal and low complement content. Complement is a system of serum proteins involved in immune responses. The low complement form is rare. It is accompanied by the development of arthritis, gastrointestinal tract, and obstructive pulmonary disease.

Urticarial form of angiitis

Henoch-Schönlein purpura

The disease (its synonym is hemorrhagic vasculitis) most often develops in childhood, often in boys 4-8 years old. It is accompanied by the appearance of purpura, noticeable to the touch, on the legs and buttocks, simultaneously with arthritis (the skin-articular form of hemorrhagic vasculitis), nephritis, and paroxysmal pain in the abdominal cavity. The disease often occurs acutely after nasopharyngeal infections. Histologically, immune complexes containing IgA are found in the tissues in and around the smallest vessels.

Henoch-Schönlein purpura

In most patients, the disease progresses favorably, but in 20% of patients kidney damage develops (cutaneous-visceral form of hemorrhagic vasculitis); this often happens when the pathology occurs in adulthood.

Damage to blood vessels and kidneys in hemorrhagic vasculitis

Vasculitis with predominant damage to medium vessels

This type includes polyarteritis nodosa. It has classic and skin varieties. The classic variant is necrotizing pathology of medium-sized arteries, not accompanied by glomerulonephritis. The disease is accompanied by muscle and joint pain, affects the skin, peripheral nerves, digestive organs, causes orchitis and congestive heart failure. The kidneys are also affected, but due to damage to medium-sized arteries, renal hypertension and renal failure occur, but not glomerulonephritis.

Skin lesions:

• purpura;
• livedo;
• ulcerative defects;
• subcutaneous nodules;
• in rare cases, gangrene of the skin on the fingertips.

In 5-7% of cases, polyarteritis nodosa is associated with viral hepatitis B.

The cutaneous form of polyarteritis nodosa occurs in 10% of cases of this disease, and is characterized only by damage to the outer covering of the body. This is the most common form of the disease in children, and is often accompanied by fever, muscle and joint pain. 20% of patients develop mononeuritis of the lower extremities.

Skin lesions are represented by painful nodules; livedo reticularis and gangrene of the nail phalanges are less common. This form of pathology is often associated with staphylococcal infection, HIV, parvovirus, hepatitis B. The disease can spontaneously stop or develop into a chronic recurrent form.

Vasculitis with damage to small and medium vessels of the skin

Cryoglobulinemic vasculitis

Cryoglobulins are proteins that precipitate when exposed to cold. They are divided into 3 subspecies. Type 1 consists of IgM antibodies, they cause blockage of blood vessels and are accompanied by blue discoloration of the extremities or Raynaud's phenomenon. Types 2 and 3 consist of antibodies directed against IgG. Cryoglobulinemic vasculitis develops in approximately 15% of patients with the presence of these proteins in the blood. This is believed to be due to their precipitation and activation of their destruction by the complement system.

Up to 75% of cases are associated with viral hepatitis C. Less commonly, autoimmune and lymphoproliferative processes are the cause.

Skin manifestations - purpura, less commonly Raynaud's phenomenon, bruising, skin nodules. Systemic signs are arthralgia, nephritis and peripheral neuropathy. It is accompanied by sensory disturbances and pain in the limbs.

Cryoglobulinemic vasculitis

Vasculitis in connective tissue diseases

Pathology can occur in patients with various autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome. The rheumatoid variant develops in 5-15% of patients with rheumatoid arthritis, usually at the final stage of the disease and with a high content (titer) of rheumatoid factor.

Skin and peripheral nerves are affected. Well-defined purpura occurs, as well as infarctions and necrosis of soft tissue at the fingertips.

Vascular damage in lupus can affect any organ and usually occurs when the disease worsens. The disease is accompanied by hemorrhages, livedo reticularis, necrosis of the skin and superficial ulcers on it.

Pathology with Sjögren's syndrome is observed in 9-32% of patients and affects the skin and central nervous system. Severe systemic lesions correlate with the presence of cryoglobulinemia in such patients.

ANCA-associated vasculitis

Antineutrophil cytoplasmic antibodies (ANCA) are directed against one's own immune cells and are detected in many diseases. They are often associated with three cutaneous forms:

• Wegener's granulomatosis;
• Churg-Strauss syndrome;
• microscopic polyangiitis.

Detection of ANCA helps diagnose these diseases. These antibodies are involved in the development of the disease and are important in predicting relapse of the pathology. ANCA-associated conditions can affect any organ system and all have a chronic course with frequent relapses.

Ulcerative-necrotizing angiitis

Diagnostics

Recognition of the disease occurs in several stages

Confirmation of skin vasculitis

If the skin is involved in the pathological process, it is necessary to perform a skin biopsy in the affected areas that arose 12-24 hours before the study. This helps to detect neutrophilic infiltration of blood vessels and make a diagnosis.

If medium-sized arteries are suspected, a deeper (wedge) skin biopsy may be needed. Samples from nodules can be taken and usually provide more information than samples from the edges of a skin ulcer or livedo reticularis.

Diagnosis of systemic diseases

After confirming the diagnosis of skin inflammation, the doctor must determine its severity and damage to other organs. External examination reveals signs of damage to internal organs, for example:

• nasal congestion;
• hemoptysis;
• dyspnea;
• blood in the urine;
• abdominal pain;
• impaired sensitivity of the limbs;
• fever;
• weight loss;
• increased blood pressure.

If involvement of internal organs is suspected or if symptoms of the pathology persist for more than 6 weeks, additional studies are prescribed:

• detailed blood test;
• biochemical analysis with determination of urea levels, residual nitrogen, creatinine, liver tests;
• diagnosis of HIV infection, hepatitis B and C;
• determination of the level of complement, rheumatoid factor, antinuclear antibodies;
• electrophoresis of serum and urine proteins.

In case of severe damage to the lungs or kidneys, the following studies are prescribed:

• antineutrophil cytoplasmic antibodies (ANCA);
• X-ray of the lungs and paranasal sinuses.

If polyarteritis nodosa is suspected, angiography is performed to evaluate microaneurysms of the vessels of the internal organs.

With an in-depth study, other causes of pathology may become apparent, such as the effect of drugs, infectious agents, or the presence of a malignant tumor. A lung or kidney biopsy is often necessary to confirm the diagnosis.

Recently, the diagnosis of vasculitis has become increasingly common. What it is? The answer to this question interests many.

Vasculitis is a whole group of autoimmune processes that affect the walls of human blood vessels. This disease has many types. The most common form is considered allergic. When a patient is diagnosed with vasculitis, what kind of disease it is, it is simply necessary to know in order to be prepared for long-term treatment and consequences.

Vasculitis takes two main forms:

• primary;
• secondary.

In its primary form, vasculitis is an independent disease. As a rule, the cause of this pathology lies in a person’s genetic predisposition. If one of the parents suffers from any form of vasculitis, then the child, under certain conditions, can also get sick. If both parents have vasculitis, the risk increases several times. The secondary form of the disease is caused by other factors, such as:

• Allergic reactions.
• Penetration of infectious agents into the body. Vasculitis very often begins after an acute infection.
• Long-term fungal diseases (including candidiasis).
• Various bacterial infections.

The disease can affect various types of blood vessels in the body. It can be:

• veins;
• capillaries;
• arteries.

Both men and women suffer from vasculitis. No connection with gender was found. Some forms of vasculitis usually appear in childhood. Hereditary predisposition is clearly visible. During the course of the disease, blood flow in damaged vessels is disrupted. Blood clots and bleeding occur. Tissues involved in the inflammatory process die. It is extremely important to diagnose this disease as early as possible. This will help avoid multiple damage to internal organs. Thanks to timely treatment and adherence to a healthy lifestyle, patients are able to achieve long-term remission. The exact cause of the disease is unclear. A proven connection with autoimmune reactions. Vasculitis can be caused by prolonged exposure to an allergen on any area of ​​the skin. It happens as a consequence of the general reaction of the body. Vasculitis can be provoked by:

• washing powder;
• detergents and cleaning products;
• dust;
• mites;
• metal objects;
• latex and much more.

In addition to the allergic nature, the impetus for the occurrence of the disease can be the penetration of a foreign agent into the body. Most types and forms of this disease begin with an acute viral or bacterial infection. Patients, as a rule, begin to notice rashes of various types with a tendency to merge. At the site of such damage, clear pigmentation remains. Vasculitis is provoked by the following infectious diseases:

• herpes viruses;
• Epstein-Barr virus;
• hepatitis;
• HIV infection;
• tuberculosis;
• syphilis;
• fungal diseases;
• staphylococci;
• streptococci;
• dysbacteriosis;
• autoimmune diseases.

If a person already has an autoimmune disease, then he has certain risks of developing other diseases. Vasculitis is no exception, so if suspicious rashes of unknown origin appear, you should consult a doctor as soon as possible. An experienced doctor will visually assess the nature of the rash and also prescribe additional examinations.

What are autoimmune processes?

Many autoimmune diseases are not fully understood. Scleroderma, systemic lupus erythematosus, rheumatoid arthritis, thyroiditis, vasculitis. What it is? A very difficult question. For the first time, such a concept as autoimmune diseases appeared at the beginning of the last century. Previously, such processes were not known at all.

In the human body there are special cells - lymphocytes. Their main task is to fight foreign objects, cleanse the body of dead cells and much more. When vaccination is carried out, for example, against hepatitis, chickenpox, tuberculosis, influenza, a very small dose of the pathogen is injected into the body. This is done so that the body becomes familiar with the foreign object and is able to overcome it. At the same time, the dose is so small that it simply cannot cause disease. A vaccinated person is no longer afraid of this infection. This is all ideal. If something goes wrong in the body, this fragile system can fail. Some types of pathogens bind to human cells. The body actively fights them, but then it begins to perceive its own cells as foreign and the autoimmune process starts. Depending on which proteins the aggression of the defense system is directed at, one or another disease is formed. Often, if this mechanism fails, serious consequences cannot be avoided. A whole series of autoimmune reactions are launched and the fight against one’s own body begins.

Causes of autoimmune processes

Despite the fact that science and medicine are actively developing, it is not yet possible to clearly indicate the cause of autoimmune processes. A number of factors contributing to the development of the disease have been identified:

• First of all, these are various infections (herpes virus, Epstein-Barr, cytomegalovirus, hepatitis, chickenpox and others).
• Various bacterial infections (staphylococcus, streptococcus).
• Protracted fungal diseases.
• Bad ecology.
• Long-term chronic diseases can also lead to autoimmune processes.
• Genetic predisposition.

Although the presence of all these factors will not necessarily lead to such consequences. As you know, everything in the body is connected. The delicate balance is disrupted - and the process can no longer be stopped. If the disease is diagnosed at an early stage, then there is every chance of stopping the process. But the predisposition still remains. When certain factors come together, the disease may manifest itself again. If the autoimmune process was not detected in time, treatment will be lengthy. This could be years, or even a lifetime. If some organs and systems are already involved in the reaction, then this can no longer be completely cured. You will have to take the drugs for the rest of your life. If you do not pay attention to such diseases, they often become systemic and destroy the entire body. This leads to disability and death. There are rare cases when the disease subsides on its own.

The most common diseases associated with aggression of the immune system:

• scleroderma;
• lupus erythematosus;
• autoimmune thyroiditis;
• vasculitis;
• rheumatoid arthritis;
• psoriasis;
• vitiligo;
• alopecia areata;
• Raynaud's syndrome and many others.

Any complaints from the patient may indicate the beginning of such a process. Although there are some signs by which one can suspect an autoimmune nature: the symmetry of the affected areas. If this is a rash on the right hand, then with an autoimmune process such a rash often appears on the left. The same applies to the remaining limbs. Very different complaints from the patient. It was as if everything in the body had gone wrong. This may be dizziness combined with hair loss and skin problems. Or inflammation of joints throughout the body. As a rule, such complaints are a very serious reason to contact a good immunologist.

Allergic vasculitis

This is an inflammatory disease of small blood vessels. Manifests itself as various skin rashes. The localization location can be any. As a rule, a rash occurs either at the site of direct contact with an allergen, or as a general reaction of the body. The causes of such a disease as allergic vasculitis can be:

• medications;
• chemicals;
• allergens;
• infections;
• autoimmune diseases.

Usually, when people hear a diagnosis of “vasculitis” from a doctor, what it is, they want to quickly find out. The disease is considered relatively curable. Achieving positive dynamics requires significant effort. In most cases, even with successful treatment, relapses occur.

Hemorrhagic vasculitis

This is an inflammatory vascular disease. The exact cause of the disease is unknown. This form also has another name - hematological vasculitis. Not everyone knows what it is. Quite often, this type of vasculitis manifests itself immediately after an infection. Small rashes appear on the body in the form of spots that have a bluish tint. They can merge with each other. They have a tendency to peel. After this rash disappears, clear pigmentation remains on the skin. Recently, cases have become more frequent when children under 12 years of age are diagnosed with hemorrhagic vasculitis. The reasons are still unknown. It occurs very rarely in children. It is also rare after the age of 12 years. Most often, this form of vasculitis affects the digestive tract and joints. How does hemorrhagic vasculitis manifest itself? What it is? Main symptoms of the disease:

• abdominal pain;
• stool disorder;
• vomit;
• fever;
• general weakness.

Systemic vasculitis

Systemic vasculitis is a severe inflammatory disease of all blood vessels, organs and tissues. It can affect the entire body, leading to disability and death. When it comes to the diagnosis of “systemic vasculitis”, what it is must be studied.

In tests, as a rule, the level of ESR is significantly increased, which indicates the presence of an inflammatory process. Systemic vasculitis can be an independent disease. But it often occurs after various infections, against the background of reduced immunity, or with oncology. Very often accompanies other autoimmune diseases. For example, such as:

• lupus erythematosus;
• Hashimoto's thyroiditis;
• scleroderma;
• rheumatoid arthritis.

Common symptoms include:

• various bluish skin rashes;
• feverish condition;
• pallor of the skin.

These are not all the symptoms. How does systemic vasculitis manifest itself, what is it? This question interests many, especially patients who are suspected of having this diagnosis.

The cause of the disease is not fully understood. As in previous cases, the following factors can be identified in the development of systemic vasculitis:

• allergic nature of the disease;
• various infectious processes in the body;
• some medications;
• other diseases of an autoimmune nature;
• hereditary predisposition.

This disease cannot be completely cured. In some cases, it is possible to achieve long-term remission, sometimes even for life. However, the affected organs cannot be restored. Maintenance therapy is prescribed. Early diagnosis is vital for this form of vasculitis. If the disease is not detected in time, the consequences will be very tragic. Treatment includes:

• Prescription of immunosuppressants. These are substances that inhibit human immunity, thereby eliminating the autoimmune reaction.
• Immunoglobulins are used to correct immunity itself.
• The affected organs and tissues are diagnosed, and based on the examination, their treatment is carried out.
• Plasmaphoresis is also used in the treatment of this disease. This procedure is called the process of blood purification.

Cutaneous vasculitis

This type is characterized by damage to the blood vessels of the skin. Divided into three types:

• dermal vasculitis;
• dermo-hypodermal;
• hypodermal.

Symptoms of cutaneous vasculitis include:

• The rash occurs on various parts of the skin, most often localized on the lower extremities. The spots can merge with each other, forming large inflamed areas of skin. The rash is usually symmetrical.
• Necrosis of affected areas.
• Sometimes swelling of the limbs.

What does vasculitis look like, what is it? The photo clearly shows this.

General symptoms of vasculitis

Common symptoms of vasculitis include:

• Various rashes of red and pink color with a bluish tint. The spots can merge with each other, forming quite large lesions.
• Deterioration in health. Weakness and increased fatigue.
• Increased body temperature.
• Changes in general blood test values. Typically, an increase in the level of ESR and white blood cells, which indicates inflammation.
• Presence of other autoimmune diseases.

Vasculitis in children

When parents are told that their child has vasculitis, “What kind of disease is this?” - one of the first questions to the doctor. If previously vasculitis was quite rare, now it is increasingly detected in children. The cause of the disease is not always found. Most likely, the problem is the bad environment, which is getting worse every year. The state of the environment negatively affects the immune system, and it fails. This serves as an impetus for the development of a number of autoimmune processes in the body. Most often, hemorrhagic vasculitis is observed in children. The reasons are unknown.

Diagnostics

Vasculitis is a serious disease, so doctors recommend diagnosing it in a hospital. Laboratory examination includes:

• general blood analysis;
• general urine analysis;
• blood for creatinine;
• liver tests;
• bacteriological blood test.

Treatment

The diagnosis “vasculitis” sounds quite ominous. What it is? Treatment? Forecast? Here are the patient's main questions.

The main treatment for vasculitis is aimed at reducing the aggression of one’s own defense system. For this purpose, drugs called immunosuppressants are used. In addition, correction is carried out with human interferon drugs. Anti-inflammatory drugs must be prescribed. Antibiotics are often prescribed if an infectious cause is found. Lifestyle is adjusted. The rest of the treatment is aimed at the consequences of vasculitis. Depending on which organ is affected, appropriate therapy is prescribed.

Forecast

If a person is diagnosed with vasculitis, what is it, interests him first of all. The prognosis, as a rule, depends on the type of vasculitis and the degree of its neglect. This disease cannot be completely cured, but by taking medications and lifestyle, you can achieve good results and forget about its unpleasant symptoms.

What can be done to prevent vasculitis?

The best means of prevention is a healthy lifestyle. To reduce the risk of vasculitis, you must follow simple rules:

• Exercise daily. This could be exercise, a morning or evening jog, or a trip to the gym.
• Get rid of bad habits. Completely eliminate or at least reduce the amount of cigarettes smoked and alcohol consumed.
• Taking a contrast shower will have a positive effect on your health.
• Walking in the fresh air will also be beneficial.
• You need to watch your diet. Don't overeat. Eat as little baked goods and sweets as possible. Try to eat more fresh vegetables and fruits.

There are vascular diseases that are particularly insidious due to the deceptive symptoms inherent in many other pathologies that have nothing to do with the vascular system. One of these diseases is vasculitis - its symptoms are often confused with a common cold, gastritis or, for example, kidney inflammation.

What is vasculitis and why does it develop?

Vasculitis is an inflammation of various groups of blood vessels - from large (arteries) to small - capillaries. The inflammatory process is triggered both as a result of an infectious lesion and due to errors of the immune system, which mistakes healthy tissues of the body for foreign and tries to destroy them.

Although the true causes of vasculitis are not yet fully understood and need confirmation, the mechanism of vascular damage in this disease has already been classified as:

• Primary pathology, affecting only the vessels themselves and not in any way related to diseases of other organs and systems;
• A secondary manifestation (symptom) of some infectious or systemic diseases - hepatitis, scarlet fever, syphilis, oncological pathologies, rheumatism, as well as allergic reactions to certain medications.

The disease is also classified according to the localization of the inflammatory process and the size of the vessels affected by it - large, medium and small.

The inflammatory process in vasculitis can affect individual organs (skin, brain and spinal cord), and be a symptom of a number of systemic pathologies - systemic lupus erythematosus, sarcoidosis, rheumatic conditions.

Such different symptoms

The symptoms of vasculitis are extremely different and depend on the localization of the inflammatory process in the vessels, so there are practically no characteristic manifestations that allow one to immediately determine the true diagnosis - especially in the early stages of the disease.

manifestation of the disease

For example, when vasculitis affects the blood vessels of the brain, patients experience severe headaches, vision may even be impaired, and if the skin is affected, characteristic rashes appear on it.

Patients may also experience asthma attacks and symptoms resembling sinusitis or otitis media. All these manifestations significantly complicate the diagnosis of the disease, so it is not for nothing that vasculitis is considered one of the most insidious pathologies.

However, there are some symptoms based on which the doctor has the right to suspect this particular disease, especially if they appear together:

• Fever (sudden and persistent increase in temperature without other signs of acute respiratory viral infection);
• Joint and muscle pain;
• Stomach ache;
• Skin rashes;
• Rapid weight loss and lack of appetite;
• General weakness.

Despite the fact that vasculitis is a relatively rare disease, experts strongly recommend that if such symptoms appear, do not attribute them to more harmless conditions and immediately undergo an examination in order to begin treatment on time.

Who suffers from this?

Vasculitis knows no age limits: you can get it both in childhood and in your seventh decade. There are no gender differences either - boys, girls, women, and men get sick. The point is only in the varieties of pathology: some forms of the disease are characteristic of childhood and adolescence, others more often manifest themselves in young, mature and elderly patients.

In children and adolescents

Symptoms

Vasculitis in children and adolescents most often occurs in a hemorrhagic form, in which the main symptom that immediately attracts attention is skin rashes.

Rashes with hemorrhagic vasculitis look like small bruises that do not disappear with pressure. The intensity of the rash can vary, manifesting itself in single small spots or multiple spots that tend to merge. When the process subsides, pigmentation remains at the site of the rash, and with relapses, peeling is observed.

Another characteristic symptom of hemorrhagic vasculitis in children, which appears in parallel with the rash or after some time, is swelling and pain in large joints: knees and ankles. In this case, joint deformation is not observed, and the symptom itself can last from several hours to several days.

Abdominal pain (abdominal syndrome), accompanied by indigestion, nausea, vomiting and diarrhea, is the third symptom that develops before or during the onset of skin and joint symptoms. Discomfort in the abdomen resembles intestinal colic during poisoning, is paroxysmal in nature and goes away on its own in a few hours or days. Sometimes abdominal syndrome is accompanied by fever.

Vasculitis in children often entails complications in the form of disruptions in work:

• Kidney;
• Lungs;
• Hearts;
• Brain.

The most common complication of hemorrhagic vasculitis in children and adolescents is the development of renal pathology, the symptoms of which can disappear quickly during treatment of the underlying disease or transform into a special form of glomerulonephritis - Henoch-Schönlein nephritis.

Pulmonary symptoms with this type of vascular inflammation manifest slightly in the form of cough and sputum streaked with blood, shortness of breath.

One of the criteria for assessing the severity of the inflammatory process in the walls of blood vessels is the appearance of disturbances in the functioning of the heart: often in children, against the background of moderate and severe forms of hemorrhagic vasculitis, functional heart murmurs are heard, hemorrhagic pericarditis and hemorrhages in the endocardium are observed, although these changes improve the patients' conditions completely disappear.

Causes

Vascular inflammation in children begins against the background of or after infectious diseases - scarlet fever, tonsillitis, hepatitis. Among the common causes of the onset of hemorrhagic vasculitis, experts also note overwork, injuries, allergic reactions to vaccinations, certain medications and foods.

Phases and variants of the course of the disease

Vasculitis in children goes through several phases: from debut to the development of severe complications in the form of renal failure.

The current may be:

• Mild - with maintaining satisfactory health and minimal symptoms (only rash and periodic pain in the joints);
• Moderately severe, when rashes and joint pain are accompanied by abdominal pain and changes in the urine (traces of protein and blood);
• Severe - this variant of the course of vasculitis is characterized by confluent rashes, necrotic ulcerations on the skin, persistent abdominal syndrome, angioedema, gastric and intestinal bleeding, and ultimately chronic renal failure.

Vasculitis also varies in duration of the process: there are fulminant, protracted and chronic forms of the disease.

The fulminant (fulminant) form of vasculitis lasts up to two months, a protracted version of the disease is spoken of six months after the onset, and the diagnosis of chronic hemorrhagic vasculitis is legitimate in cases where periods of relapse are followed by periods of remission and last for years.

Treatment

Treatment of hemorrhagic vasculitis in children is directly related to the form, severity of symptoms and duration of the disease. It is aimed at reducing the activity of the inflammatory process and alleviating symptoms.

The course of treatment includes:

• Antiplatelet agents;
• Anticoagulants;
• Fibrinolysis activators;
• Enterosorbents;
• Antihistamines (if you are prone to allergies).

In case of severe pathology, the regimen additionally includes glucocorticosteroids and cytostatics, transfusion therapy and plasmapheresis are used.

The prognosis is relatively favorable if the inflammatory process does not involve the kidneys and other abdominal organs: the development of Henoch-Schönlein nephritis can lead to chronic renal failure, and persistent abdominal syndrome can lead to peritonitis or intussusception.

The fulminant (fulminant) course of vasculitis is especially dangerous, when the patient dies within a few days or weeks from.

Disease in adults

Vasculitis in adults can be both a symptom of a number of diseases and an independent systemic pathology.

They form a large group and are of an autoimmune nature, usually occurring against the background or after various infectious diseases, since the structure of blood vessels can be damaged under the influence of immune complexes circulating in the blood.

The inflammatory process affects large, medium or small vessels, therefore the following are usually classified as systemic vasculitis:

• (damage to large arteries);
• Takayasu arteritis affecting the aorta;
• Periarteritis nodosa, in which medium-sized arteries become inflamed;
• Kawasaki syndrome, which occurs only in children and affects the coronary vessels;
• Churg-Strauss angiitis;
• Henoch-Schönlein disease;
• ANCA-associated vasculitis;
• Wegener's disease;
• Essential vasculitis;

Brief characteristics of some types

Giant cell temporal arteritis (Horton's disease) is an inflammation of the carotid arteries that affects older women (60-70 years old).

Symptoms of Horton's disease:

• Muscle pain in the shoulder girdle, hips;
• Feeling stiff in the morning;
• fast and strong weight loss;
• Fever;
• Throbbing headache on one side;
• Difficulty chewing food;
• Absence of pulse in the temporal artery;
• Visual impairment (blurredness, blindness).

Takayasu arteritis is an inflammation of the arteries seen in young women.

The symptoms of this form of the disease are:

• Lack of pulse in the arms (only one or both);
• Weakness and pain in the limbs, aggravated by exercise;
• Dizziness;
• (if the coronary arteries are involved in the process);
• Severe emaciation;
• Low-grade fever.

Nodular (nodose) periarteritis develops in young and mature men and is characterized by multiple organ damage: the digestive organs, kidneys, and heart are almost immediately involved in the inflammatory process.

Kidney damage due to periarthritis nodosa

Symptoms of periarteritis nodosa:

• Fever;
• Sharp and rapid weight loss;
• Pain in muscles and joints;
• Paresis and paresthesia of the legs;
• Signs of kidney damage;
• Arterial hypertension;
• Abdominal syndrome;
• Marbling of the skin (livedo);
• Nodules along the vessels.

Essential cryoglobulinemic vasculitis affects women over fifty years of age.

The disease is recognized by the following set of symptoms:

• Petechial rash on the skin of the legs and feet;
• Arthralgia;
• Myalgia;
• Necrotic areas and at the site of the rash;
• Kidney damage such as glomerulonephritis;
• Hemoptysis and shortness of breath.

Goodpasture syndrome is an inflammation of the capillaries in the lungs and kidneys that affects young men between 20 and 30 years of age. In this form of the disease, pulmonary and renal symptoms predominate:

• Hemoptysis or pulmonary hemorrhage;
• Changes in urine tests (appearance of protein and red blood cells);
• Focal or confluent darkening in the lungs (according to radiography);
• Progressive anemia;
• Rapid development of chronic renal failure.

Patients usually die within a year due to increasing pulmonary, cardiac and renal failure, although there are cases of a slow course with alternating periods of remission and relapse.

Allergic form

This name includes inflammation, the main symptom of which is skin lesions - papules, petechiae, ulcers caused by internal or external irritants.

Bruising for no reason

This form of inflammation of small vessels is a disease with an unclear etiology, and therefore experts name the causes of allergic vasculitis only tentatively. These include reactions to certain types of medications:

• Antibiotics;
• Contraceptives;
• Thiazide diuretics;
• Gold preparations;
• Sulfonamides.

Sometimes a form can develop after vaccination or eating certain foods. There are also cases of the disease occurring under the influence of exogenous and endogenous factors - hepatitis viruses, tumor antigens, DNA and immunoglobulins.

Allergic inflammation of small vessels of the skin quite often occurs as a result of systemic and infectious diseases:

• HIV infections;
• Primary biliary cirrhosis of the liver, hepatitis;
• Infectious mononullosis;
• Nonspecific ulcerative colitis.

Allergic vasculitis affects people of both sexes at different ages. Some forms of the disease primarily affect women, while others are “not indifferent” to men.

Symptoms

The main symptom of allergic vasculitis is purpura (a kind of rash), which is easily palpable and consists of pimples, vesicles, papules, and subcutaneous nodules. Sometimes it looks like flat spots or resembles hives.

Skin symptoms are accompanied by fever, muscle and joint pain, weakness, and lack of appetite.

Laboratory blood tests show an acceleration of ESR, leukocytosis, and an increase in the amount of C-reactive protein.

Changes in urine are characterized by the appearance of traces of protein and hematuria (blood).

Treatment

Treatment of allergic vasculitis, like any other disease of an allergic nature, begins with finding and eliminating the irritating factor (for example, stopping potentially dangerous drugs, following a diet). It happens that with just this measure it is possible to achieve complete disappearance of the symptoms of vascular inflammation.

If the disease continues, it is advisable to use drugs that stabilize the condition of the vascular walls, antihistamines (H1 and/or H2 blockers).

With further progression of allergic vasculitis and deterioration of the patients' condition, the regimen includes corticosteroids and immunosuppressors - drugs that suppress the excessive activity of the immune system and block the development of the inflammatory process.

Vasculitis is the name of one of the terrible and unpleasant ailments. You can even say that this is not one, but several diseases combined. Pathological processes affect a variety of vessels of the human body. Veins, arteries, arterioles, venoli, as well as small capillaries are susceptible to the disease. Vasculitis, what kind of disease is this, if we consider it more specifically? Inflammatory processes begin and progress in the vessels. There is a certain list of ailments that can lead to illness. This:

• polyarteritis nodosa;
• the so-called Churg-Strauss syndrome;
• microscopic polyangiitis;
• Kawasaki disease;
• Horton's disease;
• Wegener's granulomatosis, as well as others.

Vasculitis differs in severity and there is a classification. It happens that with this disease the skin suffers the most, which does not look at all aesthetically pleasing, but is unlikely to lead to death. There are types of the disease in which death is very likely.

Types of vasculitis (angiitis) are divided into classes. There are 2 main classes: primary and also secondary. With the primary disease, pathologies of small and large vessels appear as if out of the blue. The person is relatively healthy and adheres to a healthy lifestyle; there are also no allergies. Experts associate the occurrence of this disease with heredity. As for the second class, here the causes of the disease are already clearly visible. The disease may occur due to:

• hypothermia;
• overheating;
• due to infection;
• poisoning;
• skin damage using various methods;
• exposure to toxic substances.

There are not only classes, but also subclasses of the disease. The disease is classified not only by its causes. There is also a classification according to the type of vascular damage, localization, and also according to symptoms. They are distinguished: arteritis, capillaritis, granulomatous eosinophilic vasculitis, phlebitis, arteriolitis. There are also systemic and segmental vasculitis.

Causes of this terrible disease

Unpleasant vasculitis can suddenly strike a person; its causes have not been fully identified. Experts have only identified several popular theories of the occurrence of the disease. Infectious and viral diseases can give impetus to the onset of inflammatory processes in blood vessels. Viral hepatitis is especially dangerous; after it, vascular inflammation is observed most often.

Another popular version of where vasculitis comes from, the causes of its occurrence directly depend on the autoimmune disease, when the body begins to fight against itself. Immune cells, designed to protect the body, cease to normally perceive vascular cells and recognize them as foreign bodies. As a result, inflammatory processes occur. During life, the human body is influenced by many unfavorable factors. People drink contaminated water, eat foods rich in chemical additives, breathe air containing harmful substances, and take medications that are not always suitable for them. All this, together with a genetic predisposition, can cause vasculitis.

Symptoms of the disease

Vasculitis can be recognized at an early stage; its symptoms are a clear sign that should not be ignored. Vasculitis, if secondary, can become a complication of meningitis, typhoid, psoriasis, scarlet fever, cancer.

Regardless of whether a person has a primary or secondary illness, its symptoms will be the same. Adults suddenly lose their appetite and lose weight. Body temperature rises. A person gets tired quickly and constantly experiences weakness. Unsightly rashes appear on the skin. Joint pain constantly haunts me.

Vasculitis on the legs

Symptoms of vasculitis directly depend on which organ is affected. Palpable purpura is a specific type of rash. It occurs with hemorrhagic vasculitis. The rash is often observed on the elbows, as well as in the lower extremities. In addition to the rash that appears, the person suffers from fever. Vasculitis can affect the vessels that supply internal organs. Then the consequences can be very sad. If the tissues of the heart vessels are inflamed, there is a risk of heart attack. A person suffers from shortness of breath, his heart constantly hurts, and arrhythmia occurs. The disease vasculitis can affect the blood vessels of the brain. This threatens strokes. If a person has been diagnosed with Wegner's Granulomatosis, then the nose will be bothersome. Ulcers will appear on the mucous membrane. Also, I suffer from bloody discharge from the nose with pus.

Diagnosis of a terrible disease

Tests and special studies will help identify a dangerous disease. Diagnosis of vasculitis includes blood and urine tests. It is also necessary to do an angiography, undergo an ultrasound, agree to x-ray methods, with the help of which it will be possible to determine the condition of the affected vessels. If the disease has just begun to develop, then it is not easy to identify it. If the disease is already developing intensively, then it is easier to diagnose it. If several organs are already affected, then the signs will be more obvious. A blood test will reveal a decrease in hematocrit as well as hemoglobin. Thrombocytosis and leukocytosis are moderate.

In the urine of a patient whose vascular tissue is inflamed, doctors will find leukocytes, protein and red blood cells. Doctors use a biopsy to diagnose the disease. To do this, examine a piece of the diseased organ along with the vessels. After the research, it will be possible to say for sure whether a person suffers from vasculitis or not.

Treatment of the disease

Treatment of vasculitis must be timely and thorough. If the disease is advanced, then getting rid of it will be more difficult than at an early stage. What matters is how many organs of the human body are affected and how much they are damaged. If the illness occurs due to an allergy, then it is possible that it will go away on its own. Specialists will not even need to interfere in this process.

Inflammatory processes in blood vessels can disrupt the normal functioning of organs and tissues of the body. It is necessary to eliminate not only vasculitis; treatment is aimed at restoring the lost functions of internal organs. It is necessary to get rid of the serious consequences of inflammation of vascular tissue. Measures are also taken to prevent the return of the disease.

Only an experienced specialist can tell you how to treat vasculitis. Getting rid of it is not the same in all cases; on the contrary, it is often different. Hormone therapy is used. In some cases, chemotherapy is even indicated. Taking glucocorticoids helps get rid of the cause of vasculitis, an autoimmune disease. Hormonal drugs quickly suppress the unjustified activity of the immune system aimed at fighting one’s own body. By eliminating the cause, the inflammation in the blood vessels disappears, and therefore the disease goes away. The use of non-steroidal anti-inflammatory drugs is also indicated, thanks to them the person will get rid of severe pain and will also be able to reduce inflammation. Antibiotics are used for hemorrhagic vasculitis. It is also necessary to use blood thinning medications. This will prevent the formation of blood clots.

The disease vasculitis in a complicated form is treated with chemotherapy using cytostatics. Blood purification is necessary. This is achieved using hemosorption, as well as plasmapheresis. A rheumatologist is the first person a patient should contact. But, since vascular disease has many symptoms that can be signs of a variety of pathologies, you will have to get advice from different specialists so that the diagnosis ultimately turns out to be accurate.

Necessary prevention

What is vasculitis? It is better for a person to try to avoid this issue in his life. If you can avoid this pathology, then you won’t have to learn anything about it. It would be better if this issue worries only qualified doctors, but not people working in other workplaces.

It is advisable to engage in the prevention of serious illness. It is worth saying that such preventive techniques will also protect you from other diseases. Prevention will also help prolong a person's life. It is not complicated. You just need to follow simple rules. Although, often people do not find it simple at all.

A person needs to get a good night's sleep. Nutrition should be complete. There is no need to overuse salt or fatty foods. You should also be careful with smoked meats, seasonings containing sodium gluconate, and products rich in synthetic additives.

Moderate physical activity will be very beneficial for a person. If possible, you should harden yourself. You need to start doing this gradually. Don't overdo it. People should avoid high consumption of medications. In case of illness, it is advisable to consult a doctor, but do not use various drugs uncontrollably, guided by dubious considerations. If the disease returns after treatment, then you need to start fighting it as early as possible. A person who has suffered from vascular pathology and overcome it needs to monitor his health and the symptoms that arise again. If necessary, you should not delay going to the doctor. A person needs to follow all preventive measures so as not to ever find out what vasculitis is. Is it possible to cure it? Yes, it is possible, and at the present stage of medical development, curing vasculitis is not a problem.

Disease prognosis

A person, feeling unwell, first goes to a therapist. The doctor will most likely refer the patient to other specialists: an ophthalmologist, a neurologist, a rheumatologist, a cardiologist, a dermatologist, an otolaryngologist. After identifying vascular pathology, the patient may be admitted to a hospital. Treatment is unlikely to be quick. Medications and ointments are used to achieve a lasting effect. It is necessary to take into account the dangers of vasculitis. The pathology will not go away on its own. Serious consequences occur with hemorrhagic vasculitis. Pathological changes are observed in small vessels of the kidneys, intestines, joints, and skin. As for the damage to the latter, that is, joints and skin, you can get rid of the pathology in 1-2 months. There should be no special complications. But damage to internal organs threatens consequences.

Peritonitis and bleeding may occur in the intestine. Many years ago, mortality from the disease was high. Today, we have learned to deal with hemorrhagic vasculitis very successfully. The number of deaths from pathology has decreased markedly.

If the vessels of the kidneys are affected, then with the development of the disease signs of glomerulonephritis appear. The symptoms do not bother the person much. This makes the disease even more dangerous. Kidney functions decline over time and, which is very unpleasant, they can no longer be restored. Persistent renal failure develops. This leads to people becoming dependent on hemodialysis. They will no longer be able to live without constant use of the device.

Treatment of a patient with vasculitis should be individualized. Correct diagnosis is very important. It will allow you to immediately prescribe effective treatment and block the development of pathology.

Even if the pathology is quite advanced, it can still be treated. The functions of internal organs can be restored. But vasculitis should not be underestimated. They are classified as severe pathologies. The result of ineffective treatment or its complete absence can be the death of the patient.

Video about vasculitis

Vasculitis- These are diseases that affect blood vessels. Subsequently, the pathological process often spreads to different organs and tissues.

There are a large number of different types of vasculitis, each of which is accompanied by damage to a certain type of vessel and its own specific symptoms.

The most common types of vasculitis:

• Urticarial vasculitis– a disease in which small vessels are damaged, mainly venules (small veins) and spots appear on the skin like urticaria.
• Allergic vasculitis– vascular damage due to various allergic reactions.
• Hemorrhagic vasculitis (Henoch-Schönlein disease) is a disease in which there is damage to the capillaries and small arteries.
• Periarteritis nodosa– a disease that primarily affects small and medium-sized vessels.
• Nonspecific aortoarteritis (Takayasu disease) is a disease that affects the aorta and the large arteries branching from it.
• Wegener's granulomatosis– vasculitis, which affects small vessels of the upper respiratory tract, lungs and kidneys.

Types of systemic vasculitis depending on origin:

• primary– develop as an independent disease;
• secondary– arise as a manifestation of another disease.

General signs of all types of vasculitis:

• Unable to determine root cause.It is not possible to identify the factor that initially led to the onset of the disease.
• Same development. As a result of one reason or another, immunity disorders occur and autoimmune reactions develop. Antibodies are produced, which, combining with various substances, form immune complexes. The latter settle on the walls of blood vessels and cause inflammation.
• Chronic course. All systemic vasculitis occurs over a long period of time. Exacerbations and remissions (improvement of condition) alternate.
• The same factors usually lead to exacerbations: administration of vaccines, various infections, hypothermia, prolonged exposure to the sun, contact with allergens.
• Damage to various organs and tissues: skin, joints, internal organs. Autoimmune processes develop throughout the body, but mainly in those places where there are large concentrations of blood vessels.
• For all types of vasculitis, medications that suppress the immune system help.

Anatomy of blood vessels

The wall of any artery consists of three layers: inner, middle and outer. They can have different structures and thicknesses, depending on the size, position and function of the artery.

Types of arteries:

• elastic;
• muscular;
• mixed.

The structure of the walls of arteries depending on the type:

Type of arteries	Wall structure
Elastic. The aorta and other large vessels are structured according to the elastic type. Their task is to provide a constant flow of large amounts of blood under high pressure.	The inner layer is represented by endothelium, which makes up 20% of the wall thickness. These are the cells lining the lumen of the vessel from the inside. They ensure normal blood movement and prevent the formation of blood clots. Under the endothelium there is loose tissue connecting it to the middle layer. It is in it that cholesterol plaques form during atherosclerosis.
	The middle layer is represented by multilayer elastic membranes, in which there are holes - windows.
	The outer layer of elastic arteries is thin and consists of loose tissue and fibers. It is designed to protect the vessel from overstretching and rupture. The vessels and nerves supplying the artery pass through here.
Muscular. Arteries of the muscular type are also called distributive. Their walls contain muscle fibers, with the help of which the lumen of the vessel can quickly change. Muscle-type arteries can increase or restrict blood flow to a particular part of the body. Muscular arteries are large vessels that are branches of the aorta and supply blood to large areas of the body.	The inner layer of muscular arteries is practically no different from the elastic one. It consists of: endothelium; a layer of loose tissue underneath; membrane separating the inner layer from the middle one.
	The middle layer consists of muscle fibers that are arranged in a spiral and cover the entire vessel. By contracting, they reduce the lumen of the vessel and partially block the blood flow.
	The outer shell is a fabric with a large number of fibers. Nerves and blood vessels pass through it.
Mixed (muscular-elastic).	In structure they occupy a middle position between arteries of the muscular and elastic types. Their middle layer contains both fibers and muscle cells. Mixed arteries are small and medium-sized vessels. As their diameter decreases, the walls become thinner.
Arterioles	Arterioles are the smallest arteries that connect the arterial system to the capillaries. The wall of arterioles is very thin. It consists of the same layers as the wall of the arteries: The inner layer is the endothelium, located on a membrane film. The middle layer is muscle cells. They are arranged in two layers. The junction between the arteriole and the capillary is covered by one muscle cell: by contracting and relaxing, it regulates the flow of blood into the capillaries. There are spaces between the endothelial cells of arterioles. Therefore, hormones and other substances that enter the bloodstream can quickly act directly on muscle cells. The outer layer of arterioles consists of connective tissue and is very thin.
Capillaries	Capillaries are the final section of the bloodstream. These are the smallest vessels connecting arterioles to venules. Gas exchange between blood and tissues occurs in capillaries; here arterial blood turns into venous blood. Different organs have different numbers of capillaries. Their density is highest in the brain and heart. Normally, in a calm state, only 50% of the capillaries are active.

Allergic vasculitis

Allergic vasculitis is an allergic-inflammatory disease that primarily affects small vessels located in the skin. It can occur in different ways and be accompanied by the appearance of various skin rashes. Some of its forms are identified as independent diseases. This creates difficulties during diagnosis. Allergic vasculitis can develop at any age, equally often in men and women.

Causes of allergic vasculitis

Despite the word “allergic” in the name, this type of vasculitis is caused by a combination of different factors:

• infections: staphylococci and other bacteria, viruses, fungi;
• chronic foci of inflammation in the body: tuberculosis, chronic cystitis, adnexitis, sinusitis, tonsillitis, etc.;
• frequent colds;
• taking certain medications: antibiotics, painkillers, sedatives, contraceptives, etc.;
• contact with certain chemicals(mostly occupational hazards);
• exposure to radiation, frequent exposure during radiation therapy for cancer;
• cardiovascular diseases: arterial hypertension, varicose veins, heart failure;
• some chronic diseases: obesity, type II diabetes mellitus, gout etc.

Manifestations of allergic vasculitis

The symptoms of allergic vasculitis depend on the form in which it occurs.

Manifestations of allergic vasculitis depending on the form of the disease:

Description	Appearance of elements on the skin
Hemorrhagic vasculitis (Henoch-Schönlein disease) - see below, described separately.
Allergic arteriolitis of Rutera
There are many different types of skin rashes: blisters, red spots, spider veins, pustules, blisters, ulcers. Headache. Increase in body temperature, usually up to 37⁰C. Pain, inflammation in the joints.
Nodular necrotizing vasculitis
This form of the disease usually occurs chronically over a long period of time. There is always a significant deterioration in the patient's general condition. Red spots, hemorrhages, and nodules appear on the skin, which then ulcerate.
Erythema nodosum
The disease can occur in acute or chronic form. Small nodules and larger nodules form on the skin. The lesion is mainly localized on the anterior surface of the legs. There may be pain and inflammation in the joints.

Diagnosis of allergic vasculitis

The manifestations of different types of allergic vasculitis vary greatly. Therefore, after identifying complaints and examining the patient, it is very difficult to make a diagnosis.

Examination for allergic vasculitis:

Diagnostic method	What does it reveal?	How is it carried out?
General blood analysis	General clinical analysis. It is carried out in patients with suspected diseases. In allergic vasculitis, inflammatory changes are detected: acceleration of erythrocyte sedimentation; increase in the number of immune cells - leukocytes.	Blood is drawn from a finger or a vein, usually early in the morning.
Skin biopsy	The main method for diagnosing allergic vasculitis. The doctor takes a small piece of the patient's skin and sends it to the laboratory for examination under a microscope. After this, you can say exactly what pathological changes are occurring in the skin.	The doctor obtains a piece of skin using a special razor (a small piece of skin is removed, the procedure is almost painless) or a needle.
	Aimed at identifying specific antibodies and immune cells that are involved in the development of an allergic reaction.	For immunological studies, a small amount of blood is usually taken from a vein.

Also, in case of allergic vasculitis, an examination is aimed at:

• identification of chronic foci that could contribute to the onset of the disease;
• identifying infections that could contribute to the onset of the disease;
• identification of complications from joints, heart, etc.

The examination program is drawn up individually by the doctor.

Treatment of allergic vasculitis

Drug name	Description, effects	Mode of application
Antiallergic drugs: Pipolfen; Telfast; Calcium chloride, etc.	Suppress allergic reactions that underlie vascular inflammation in allergic vasculitis.	Suprastin: For adults: 1 tablet 3 – 4 times a day For children Pipolfen: For adults: 0.5 ampoules intramuscularly, 1 time per day or every 4 to 6 hours, depending on the doctor’s prescription. For children: depending on age and weight, as prescribed by a doctor. Telfast Adults and children over 12 years of age take 1 tablet daily.
Venoruton (syn.: Rutoside)	Effects: strengthens vascular walls; reduces the fragility of small vessels; prevents the formation of blood clots; protects the inner surface of the walls of blood vessels from the action of various substances.	Release form: In capsules of 300 mg. Mode of application: Take 1 capsule 3 times a day until symptoms disappear.
Dicynone (syn.: Etamsylate)	Effects: strengthens the walls of blood vessels; normalizes the permeability of vascular walls for various substances; improves blood circulation in the skin and various organs; normalizes the process of blood clot formation.	Release forms: ampoules with solution for injection, 2 ml; tablets 250 mg. Directions for use: In ampoules: intramuscularly, 1 ampoule 2 times a day. In tablets: 1 - 2 tablets 3 times a day. The duration of treatment is determined by the attending physician.
Askorutin	Combined vitamin preparation, a combination of ascorbic acid (vitamin C) and rutin (vitamin H). Both vitamins have a strengthening effect on the vascular wall, protect cells and tissues from oxidation by free radicals.	Release form Mode of application:
Prodectin (syn.: Pyricarbate)	This drug belongs to the group of angioprotectors - drugs that protect the walls of blood vessels from damage. Effects: restoration of blood flow in small vessels; elimination of inflammation; decreased permeability of the vascular wall to various substances; suppression of platelet adhesion and reduction of blood clotting; preventing the formation of atherosclerotic plaques; eliminating redness and itching of the skin.	Release forms: ointment; pills. Methods of application: ointment: apply a thin layer to the skin, rubbing lightly, 2 times a day, apply a bandage on top; pills: take 250 – 500 mg of the drug 2 times a day, as prescribed by your doctor.
Aminocaproic acid	It is a hemostatic agent. It is used for allergic vasculitis, accompanied by hemorrhages from small vessels.	Release forms: powder in packages for oral administration of 500 g; 5% solution in 100 ml bottles for intravenous administration; granules 60 g for children. Methods of application: In the form of powder and granules, aminocaproic acid is taken every 4 hours at the rate of 0.1 g of the drug per kilogram of body weight. 100 ml of solution is administered intravenously as a dropper. If necessary, repeat the administration after 4 hours (strictly as prescribed by the doctor!)
Aescusan	Herbal preparation, horse chestnut extract. It is an angioprotector, protects blood vessels from damage. Effects: decreased permeability of the vascular wall; increased tone of small vessels; elimination of inflammation.	Release forms: solution in bottles for oral administration; pills. Mode of application: solution: 10 – 20 drops 3 times a day; pills

Treatment methods for severe allergic vasculitis:

• glucocorticoids– adrenal cortex drugs that suppress the immune system;
• cytostatics– drugs that suppress the immune system;
• hemosorption and plasmapheresis– hardware methods for purifying blood from immune complexes and toxic substances (see below when describing periarteritis nodosa).

Urticarial vasculitis

Urticarial vasculitis can be considered a type of allergic vasculitis. Synonym for the name of the disease - The disease is rare. Outwardly it resembles an allergic reaction like urticaria.

Causes of urticarial vasculitis

Urticarial vasculitis is of allergic origin. Unlike regular allergies, symptoms do not go away immediately after you stop contact with the suspected allergen. This type of vasculitis is prone to chronicity.

Symptoms of urticarial vasculitis:

The main symptom of urticarial vasculitis is a rash. It resembles that of urticaria: red blisters appear on the skin.

Differences between urticaria rash and urticarial vasculitis:

Characteristic	Hives	Urticarial vasculitis
Blister density	Average	Very dense
How long does the rash last?	Short-term, quickly passes after cessation of contact with the allergen.	Lasts longer than 24 hours, usually 3 – 4 days.
Is there any itching?	Eat.	No, instead there is pain and burning.
What remains at the site of the rash after it disappears?	It passes without a trace.	Subcutaneous hemorrhages, green and yellow bruises, and age spots remain.
Does this affect the general condition of the patient?	Virtually no disruption. The main problems are related to itching.	It is disrupted and there is an increase in body temperature.
Are other organs affected?	Characteristic symptoms of allergic reactions: Quincke's edema (swelling on the face); cough, shortness of breath, suffocation (due to swelling of the larynx and bronchi).	joint pain; indigestion; glomerulonephritis is an inflammatory process in the kidneys.

Diagnosis of urticarial vasculitis

Study	Description	How is it carried out?
General blood analysis	An acceleration of erythrocyte sedimentation is detected - a sign of an inflammatory process.	To perform a complete blood count, blood is usually taken from a finger or a vein.
Immunological studies	An increase in the concentration of antibodies and some other substances responsible for autoimmune inflammation is detected.	For testing, blood is usually taken from a vein.
General urine analysis	Finding blood and protein in the urine indicates kidney involvement.
Skin biopsy	It is the main, most informative method for urticarial vasculitis. This is the study of a fragment of a patient's skin under a microscope. Signs of inflammation and necrosis (tissue death) are detected.	The skin for examination is taken using a scraping, a needle, or a small fragment is cut off with a scalpel.

Treatment of urticarial vasculitis

Treatment of urticarial vasculitis is carried out according to the same principles as the treatment of all other allergic vasculitis (see “allergic vasculitis”, “hemorrhagic vasculitis”):

• if these drugs are ineffective - glucocorticoids (drugs of adrenal hormones) and cytostatics (drugs that suppress the immune system).

Hemorrhagic vasculitis

Hemorrhagic vasculitis (Henoch-Schönlein disease) is a type of vasculitis that affects small vessels, followed by the skin, joints, and internal organs. The disease is most common in childhood and young adults.

Causes of hemorrhagic vasculitis

Hemorrhagic vasculitis is an autoimmune disease. Due to the excessive reaction of the immune system, a large number of immune complexes are formed in the blood. By settling on the walls of blood vessels from the inside, they lead to the development of inflammation.

Factors provoking the development of hemorrhagic vasculitis:

• angina– inflammation of the tonsils caused by streptococcal bacteria;
• exacerbation of chronic inflammation of the tonsils(tonsillitis);
• pharyngitis– inflammation of the pharynx caused by infection;
• administration of certain vaccines and serums, to which the patient has intolerance;
• hypothermia.

Signs of hemorrhagic vasculitis

Group of symptoms	Description
General symptoms	increased body temperature; fever;
Skin lesions
Signs of joint damage (detected in 75% of patients)	Large joints are more often affected; there is pain and swelling; the intensity and duration of pain can vary greatly; impaired joint mobility (often associated with hemorrhage into the joint).
Signs of damage to internal organs	sharp stabbing or cramping pain in the abdomen; most often the pain is localized around the navel, sometimes in other parts of the abdomen; vomiting with blood; blood in the stool; with kidney damage - blood in the urine.

Diagnosis of hemorrhagic vasculitis

Study	What does it reveal?	How is it carried out?
General blood analysis	In a general blood test for hemorrhagic vasculitis, inflammatory changes are detected: increase in the number of leukocytes. The platelet count is within the normal range - this is a sign that the hemorrhages under the skin are not caused by a decrease in blood clotting.	For analysis, blood is taken from a finger or vein, usually in the morning.
Blood chemistry	an increase in the amount of immune proteins - immunoglobulins; an increase in the content of fibrinogen, a protein responsible for blood clotting.	For analysis, blood is taken from a vein on an empty stomach.
Blood clotting test.	Specific analyzes and tests aimed at studying blood clotting. All indicators are normal, and this helps to prove that hemorrhages under the skin are not caused by bleeding disorders.	For analysis, blood is taken from a finger or vein.
Immunological studies	Determination of the content of antibodies, immune complexes, and some other substances in the blood that are responsible for the autoimmune inflammatory process.	For analysis, blood is taken from a vein.
Skin biopsy	Examination of a skin fragment under a microscope.	Allows you to accurately determine the pathological process occurring in the tissue.

Treatment of hemorrhagic vasculitis

A drug	Description	Mode of application
General treatment for hemorrhagic vasculitis
Askorutin	Combined vitamin preparation, a combination of ascorbic acid (vitamin C) and rutin (vitamin P). Both vitamins have a strengthening effect on the vascular wall, protect cells and tissues from oxidation by free radicals.	Release form: light green tablets, each containing 50 mg of rutin and ascorbic acid. Mode of application: Adults take 1 tablet after meals 1 – 2 times a day. The duration of the course is determined by the doctor individually.
Indomethacin	Anti-inflammatory drug. Suppresses the inflammatory process in blood vessels and eliminates the symptoms of the disease. Prescribed for long-term persistent hemorrhagic vasculitis.	Release forms: tablets of 0.025, 0.01 and 0.005 g; capsules of 0.05, 0.03 and 0.02 g. Mode of application: 150 – 200 mg of the drug per day. After the symptoms subside, the dose is reduced by half.
Hingamin (syn.: Delagil)	An antimalarial drug that can suppress the immune system.
Hydroxychloroquine (syn.: Plaquenil)	Analogue of Hingamin. Has an antibacterial effect and suppresses the immune system.	Taken as prescribed by a doctor.
In case of damage to the internal organs of the abdomen
Heparin	Heparin is an anticoagulant - it reduces blood clotting.	The dose of the drug is selected depending on the severity of the symptoms. Prescribed by a doctor in a hospital.
Fresh frozen plasma	Fresh frozen plasma is obtained from donors at blood transfusion centers. It contains natural organic substances that normalize blood clotting and its other properties.	300–400 ml of plasma is administered intravenously. The procedure is carried out only in a hospital setting, for 3 to 4 days.
Curantil (syn.: Dipyridamole)	Effects: decreased blood clotting; protection of the walls of small vessels from damage; improvement of blood flow in small vessels.	Release form: Dragees and tablets of 25 and 75 mg. Mode of application: Take 75–225 g of the drug per day, dividing the total dose into several doses (as prescribed by your doctor). The tablets are taken on an empty stomach.
Trental (syn.: Pentoxifylline)	Effects: normalizes blood viscosity; dilates blood vessels; normalizes blood flow in organs and tissues.	Release forms: in tablets of 100 and 400 mg; in the form of a solution for injection in ampoules of 5 ml. Methods of application: In tablets: 1 tablet 3 times a day. In the form of injections: intravenously, in a dropper, dissolving the contents of two ampoules in 150 ml of saline solution.
For kidney damage
Delagil (syn.: chloroquine)	An antimalarial drug that has the ability to suppress immunity and autoimmune reactions.	Taken strictly as prescribed by a doctor.
Plaquenil	See above.	See above.

Periarteritis nodosa

Periarteritis nodosa is an allergic vasculitis in which small and medium-sized arteries are predominantly affected. Most often, the disease develops between the ages of 30 and 50 years. Men suffer 2–4 times more often than women.

Causes of periarteritis nodosa

Factors contributing to the development of this type of vasculitis:

• taking certain medications: antibiotics, painkillers, anti-tuberculosis, X-ray contrast agents;
• viral infections: hepatitis B, herpes, cytomegalovirus infection;
• genetic predisposition.

Processes occurring in the vessels during periarteritis nodosa:

• development of autoimmune inflammation in the vascular wall, as a result of which it is destroyed, grows and increases blood clotting;
• blocking the lumen of blood vessels, as a result of which the blood supply to organs is disrupted;
• vascular thrombosis;
• aneurysms(thinning of the wall) and ruptures of blood vessels;
• heart attacks(death of tissue as a result of cessation of blood circulation) in internal organs, after which atrophy and scarring develop, functions are disrupted.

Symptoms of periarteritis nodosa

Symptom	Explanation
Increased body temperature, fever	fever is usually the first symptom of the disease; is of an irregular nature: body temperature can rise and fall at any time of the day, for no apparent reason; after taking antibiotics, body temperature does not decrease; The fever goes away as other symptoms occur.
Weight loss	very strongly expressed; Doctors often make mistakes and suspect a malignant tumor in a patient.
Pain in muscles and joints	most pronounced at the onset of the disease; The calf muscles and knee joints are most often affected.
Skin rashes	Types of skin rash with periarteritis nodosa: red spots; red spots and blisters; hemorrhages; bubbles; specific nodules along the vessels under the skin; areas of dead skin.
Damage to the cardiovascular system	angina pectoris(damage to blood vessels supplying the heart); myocardial infarction; arterial hypertension(increased blood pressure); heart failure; phlebitis(inflammation of the veins), which occurs periodically in different places; Raynaud's syndrome(damage to small vessels of the hands): attacks during which numbness of the fingers occurs, their paleness, unpleasant sensations in the form of tingling, “crawling goosebumps”, pain.
Kidney damage	glomerulonephritis(as a result of impaired blood supply to the kidneys and their damage by immune complexes); renal vascular thrombosis– rare manifestation; renal failure– impaired renal function during a long course of the disease.
Nervous system lesions	mononeuritis– damage to any sufficiently large nerve due to disruption of its blood supply; polyneuritis– damage to a large number of small nerves due to disruption of the blood supply; seizures of the epileptic type.
Lung damage	pneumonitis – pneumonia, which, unlike pneumonia, is caused not by infection, but by an autoimmune process.
Damage to the abdominal organs	stomach ache; digestive disorders: bloating, feeling of heaviness, belching, etc.; blood in stool; enlarged liver, feeling of heaviness under the right rib; intestinal ulcers; signs reminiscent of pancreatic diseases: girdle pain in the upper abdomen, nausea, vomiting, digestive disorders after eating large amounts of fatty, fried foods.

What does periarteritis nodosa look like in the photo?

Erythema (red spots)
Maculopapular rash (red spots and blisters)
Hemorrhages (bleedings)
Vesicles (bubbles)
Specific nodules along the vessels under the skin.
Necrosis (areas of dead skin).

Diagnosis of periarteritis nodosa

Study title	Why is it carried out and what does it reveal?	How is it carried out?
General blood analysis	Helps identify the inflammatory process in the body: increased erythrocyte sedimentation rate; increased leukocyte count; increased content of eosinophils - “allergic” leukocytes; sometimes anemia is detected.	For the test, a small amount of blood is taken from a finger or a vein.
Blood chemistry	Helps identify the inflammatory process: disturbance of the protein composition of the blood: immunoglobulins (antibody proteins) begin to predominate; identification of C-reactive protein, which is a characteristic marker of the inflammatory process.	For the study, a small amount of blood is taken from a vein in the morning on an empty stomach.
Research aimed at identifying pathological changes in internal organs.	Kidney damage: detection of protein and red blood cells in a general urine test. In case of heart damage: changes in the electrocardiogram, increase in heart size on x-rays, ultrasound. For severe muscle pain a biopsy is performed - taking a small amount of muscle tissue for examination under a microscope.

Treatment of periarteritis nodosa

Drug name	Description and purpose of destination	Mode of application
Prednisolone (syn.: Prednisol, Prednihexal, Medopred)	A drug of the adrenal cortex hormone, which has a pronounced ability to suppress immune reactions and inflammation.	Release forms: For periarteritis nodosa, the drug is used in tablets of 0.005 g (respectively, 5 mg). Mode of application: The dosage of the drug is determined by the attending physician, depending on the activity of the process and the severity of symptoms. Treatment is carried out for 1 – 2 months. First, the maximum dose is prescribed, then it is reduced.
Cyclophosphamide (syn.: Cyclophosphamide, Cytoxan, Endoxan)	Belongs to the group of cytostatics. Suppresses the proliferation of lymphocytes - immune cells that produce antibodies. Thus, it suppresses immune reactions and eliminates autoimmune inflammation.	The drug is prescribed for fairly severe periarteritis nodosa. It is used in strictly defined dosages, exclusively as prescribed by a doctor. Accepted for 3 – 5 years.
Azathioprine (syn.: Imuran)	It is an immunosuppressant - suppresses the immune system, thereby eliminating autoimmune inflammation.	It is used in strictly defined dosages, exclusively as prescribed by a doctor.
Hemosorption and plasmapheresis	Hemosorption is a procedure during which blood is passed through special layers of sorbent outside the body. Plasmapheresis – purification of plasma using various methods: replacement with donor plasma; plasma purification in a centrifuge; plasma settling; passing blood plasma through a membrane that acts as a filter. Both procedures are aimed at cleansing the blood of immune complexes that cause vascular damage in periarteritis nodosa.	The plasmapheresis procedure lasts on average about 1.5 hours. The patient lies down in a special chair, and a needle connected to a machine is inserted into his vein. To effectively cleanse the blood, 3 to 5 procedures are usually required. Hemosorption is carried out under similar conditions, in rooms equipped like operating rooms. A needle connected to a machine is inserted into the vein. The blood is pumped using a pump through a special container filled with sorbent. On average, the procedure lasts 1–2 hours, during which time 6–9 liters of blood are purified.
Nicotinic acid (syn.: vitamin B3, niacin, vitamin PP)	Effects: dilation of small vessels and improvement of microcirculation; reducing the level of harmful fats in the blood; reducing blood cholesterol levels and slowing down the formation of cholesterol plaques. Nicotinic acid is used for periarteritis nodosa as a symptomatic remedy to improve blood circulation.	For periarteritis nodosa, nicotinic acid tablets of 0.05 g are used. Mode of application: adults: ½ - 1 tablet 2 - 3 times a day; children: 1/5 - ½ tablets 2 - 3 times a day.
Parmidine (syn.: Prodectin)	It is an angioprotector - a medicinal substance that strengthens the vascular wall and protects it from damage.	Release form: tablets 0.25 g. Mode of application: 1 – 3 tablets 3 – 4 times a day. The course of treatment, as prescribed by a doctor, can last from 2 to 6 months.
Electrophoresis with novocaine on legs	Electrophoresis is a type of physiotherapy in which medications are introduced into the body through the skin using an electric current. Electrophoresis with novocaine is used to eliminate pain.	During the procedure, the doctor places two electrodes wrapped in a cloth soaked in a drug solution on the skin of the patient’s lower extremities. Then the device is adjusted so that the patient feels a slight tingling sensation. The procedure is usually carried out within 5 – 15 minutes. In general, the course consists of 10 sessions.

Treatment of periarteritis nodosa includes mandatory correction of blood pressure. The patient is prescribed drugs that lower blood pressure and diuretics.

Nonspecific aortoarteritis (Takayasu disease)

Nonspecific aortoarteritis is a chronic disease in which an inflammatory process develops in the aorta and large vessels extending from it. Less commonly, the disease may involve the pulmonary arteries.

The disease, like other systemic vasculitis, is rare. Women get sick 3 to 8 times more often than men.

Causes of nonspecific aortoarteritis

The causes of the disease have not yet been fully elucidated. It is believed that two factors are involved in the development of nonspecific aortoarteritis:

• Autoimmune process. As with periarteritis nodosa, specific immune complexes are formed that cause damage to the vascular wall.
• Hereditary predisposition. The presence of certain genes increases the likelihood of developing the disease.

Manifestations of Takayasu's disease

Pathological changes in vessels with nonspecific aortoarteritis occur in two stages:

• Initially, under the influence of immune cells, specific growths - granulomas - appear on the inner wall of the vessel.
• Subsequently, the inflammatory process gives way to scarring, and vascular sclerosis occurs.

Group of symptoms	Signs
Signs indicating the development of the inflammatory process. Usually occur at the very beginning of the disease, in young people (about 20 years old)	significant increase in body temperature, chills; increased fatigue, drowsiness; pain in joints and muscles.
Disruption of blood flow to the brain	dizziness; headache; tinnitus, “floaters before the eyes”; frequent fainting; general weakness, increased fatigue, drowsiness; absent-mindedness, impaired memory, attention, etc.; blurred vision, decreased acuity;
Increased blood pressure	Symptoms characteristic of arterial hypertension occur. When the abdominal part of the aorta and the renal vessels extending from it are damaged, the flow of blood and oxygen to the kidneys is disrupted. Pathological mechanisms are triggered, leading to an increase in blood pressure. If the aortic arch and the vessels extending to the upper extremities are affected, then different blood pressure readings are noted on the right and left arms.
Damage to the coronary (coronary) arteries, which arise from the aorta and carry blood to the heart muscle.	increased fatigue, weakness; symptoms of angina pectoris: periodic severe pain in the chest; increased risk of heart attack.
Damage to the abdominal aorta and the vessels that extend from it to the abdominal organs.	periodic abdominal pain; bloating; indigestion.
Damage to the pulmonary arteries, which carry venous blood to the lungs.	shortness of breath, rapid fatigue during physical work; chest pain; sometimes - a cough, during which sputum mixed with blood is released.

All the symptoms described occur with a large number of other diseases. Therefore, during a direct examination, it can be difficult for a doctor to establish an accurate diagnosis. It is confirmed only after a complex of laboratory and instrumental studies.

Diagnosis of nonspecific aortoarteritis

Diagnostic method	Description
Ultrasound examination of blood vessels	Using an ultrasound sensor, the doctor can visualize large vessels, determine the thickness of their lumen, and detect existing narrowings.
Dopplerography	Dopplerography is an addition to ultrasound examination, allowing one to assess the intensity of blood flow in the vessels and, thus, judge its disturbances.
Duplex scanning	Combination of Dopplerography with classical ultrasound examination. Allows you to create the most complete picture of the lumen of large vessels and the intensity of blood flow in them.
Rheovasography	The older method of studying blood flow in vessels has today been almost completely replaced by Dopplerography. The body is exposed to high frequency current and the electrical resistance of the blood vessels is measured. Based on the data obtained, blood flow is assessed.
Ultrasound examination of the heart and kidneys	Allows to identify disorders in these organs caused by damage to large vessels.
Angiography	A study during which a radiopaque contrast agent is injected into the vessels, after which X-rays are taken. Gives an idea of ​​the degree of blockage of the lumen of blood vessels. Kidney angiography is often performed - it gives an idea of ​​​​the degree of disruption of blood flow in them. Coronary angiography (angiography of the coronary arteries of the heart) helps identify narrowing sites in the coronary arteries.
General blood analysis	With nonspecific aortoarteritis, inflammatory changes are detected in a general blood test: increase in the number of leukocytes; acceleration of erythrocyte sedimentation.
General urine analysis	A general urine test for aortoarteritis helps identify signs of kidney damage: protein impurities in the urine; admixtures of red blood cells.

Treatment of nonspecific aortoarteritis

Medicine	Description	Mode of application
Prednisolone	A drug created on the basis of hormones of the adrenal cortex. Inhibits the reproduction and function of immune cells. Helps reduce antibody production. Due to this, it suppresses autoimmune processes leading to inflammation of the vascular wall in nonspecific aortoarteritis.	Prednisolone for long-term use is available in tablets. Dosages are prescribed exclusively by the attending physician, depending on the severity of the disease and the severity of symptoms. Prednisolone is taken in maximum dosages for 1 to 2 months. Then the dose is reduced and administration is continued for 1 to 2 years.
Azathioprine	Cytostatic. A powerful immune system suppressant.	It is used strictly as prescribed by a doctor, depending on the severity of the disease and the severity of symptoms. During the first month, the highest dose is prescribed. Then, throughout the year, a lower, supportive one.
Anti-inflammatory drugs: Diclofenac (Ortofen, Voltaren); Indomethacin.	Suppress the inflammatory process. Prescribed for chronic disease.	Dosages and duration of therapy are strictly as prescribed by the doctor.
Drugs that reduce blood clotting: heparin; persantine; dipyridamole; pentoxifylline; chimes.	Prevents the formation of blood clots. Used for chronic disease.	Dosages and course duration are strictly as prescribed by the doctor.
Drugs that break up blood clots: streptokinase; urokinase; fibrinolysin.	These drugs dissolve blood clots that have already formed in the blood vessels.	They are used for complications associated with poor circulation in internal organs (heart, kidneys, etc.).

In case of nonspecific aortoarteritis, it is necessary to combat high blood pressure. The doctor must select medications for his patient, taking into account the fact that arterial hypertension is caused by poor circulation in the kidneys.

Surgical treatment of nonspecific aortoarteritis

Indications for surgical treatment of nonspecific aortoarteritis:

• significant impairment of blood flow in the kidneys;
• significant circulatory impairment in the brain;
• poor circulation in the extremities, gangrene.

Usually a bypass operation is performed - the doctor replaces the affected area of ​​the vessel with one taken from another area of ​​the body or with an artificial implant.

Wegener's granulomatosis

Wegener's granulomatosis is a systemic vasculitis that affects the small vessels of the respiratory and kidney organs. The disease occurs in men and women with equal frequency. On average, its onset occurs at the age of 40 years.

Causes of Wegener's granulomatosis

The exact causes of this type of vascular vasculitis are not known.

Factors that play a role in its occurrence:

• various infectious diseases;
• autoimmune reactions.

Signs of Wegener's granulomatosis

Groups of symptoms for Wegener's granulomatosis:

• symptoms of upper respiratory tract damage;
• symptoms of lung damage;
• symptoms of kidney damage.

Types of Wegener's granulomatosis depending on the course of the disease:

• Local: the lesion affects only the upper respiratory tract.
• Limited: the lesion involves the upper respiratory tract and lungs. In this case, the kidney vessels are not affected.
• Generalized: damage to the lungs, upper respiratory tract and kidneys is noted.

Group of symptoms	Manifestations
Nasal lesion	feeling of dryness in the nose; difficulty breathing through the nose; nosebleeds
Purulent inflammation of the ear (otitis)	increased body temperature, fever; disturbance of general well-being; ear pain; Otitis media with Wegener's granulomatosis is often accompanied by joint pain.
Damage to the pharynx and larynx	dry cough; hoarse voice; sore throat.
Lung damage	increased body temperature; hacking cough; Sometimes when you cough, blood comes out.
Kidney damage	pain in the lumbar region; increased body temperature; a sharp decrease in the amount of urine.
Joint involvement (rare)	joint pain; swelling in the joint area; disturbances in joint movements.
Cardiac involvement (rare)	signs of myocarditis - inflammation of the heart muscle; signs of pericarditis - inflammation of the outer lining of the heart; pain behind the sternum, as with angina pectoris; myocardial infarction.
Damage to the digestive system (rare manifestation)	stomach ache; lack of appetite; bloody stool, black tarry stools; enlarged liver, heaviness under the right rib.

As you can see, the symptoms of Wegener's granulomatosis are very diverse and not always unambiguous. The disease occurs in different forms, and its course itself is also often different. Therefore, it is very difficult to suspect this pathology during an examination. Typically, a doctor thinks about Wegener's granulomatosis in the case when the patient has been suffering from a “cold” disease for a long time, which does not respond to conventional treatment, and protein is detected in a general urine test.

An accurate diagnosis is established after an examination.

Diagnosis of Wegener's granulomatosis

Type of study	Description
Rhinoscopy	Examination of the nasal cavity by an ENT doctor using a special instrument - a rhinoscope. The doctor examines the mucous membrane of the nasal cavity and assesses its condition.
Laryngoscopy	Examination of the larynx using a special device - a laryngoscope. It is carried out under anesthesia. The doctor examines the patient's laryngeal mucosa and assesses its condition.
Biopsy of the nasal mucosa	A fragment of the nasal mucosa is collected using special endoscopic equipment. The resulting material is then sent to the laboratory, where it is subjected to microscopy. A biopsy helps distinguish Wegener's granulomatosis from other nasal diseases, such as tumors, etc.
X-ray, X-ray tomography of the lungs	During an X-ray examination, a large number of small compactions are detected in the lungs. Can reveal small cavities with walls.
Computed tomography, magnetic resonance imaging of the lungs	They are more accurate compared to radiography methods. They help clarify the data obtained during an x-ray examination.
Electrocardiography (ECG)	Used for signs of heart damage. During the study, increased loads on the left ventricle and thickening of its wall are revealed.
Kidney ultrasound	During an ultrasound examination, the doctor assesses the condition of the kidneys and their vessels. The test helps distinguish Wegener's granulomatosis from other kidney diseases.
Kidney biopsy	Taking a piece of kidney tissue for examination under a microscope. It is carried out using a needle that is inserted through the skin.
General blood analysis	: increased erythrocyte sedimentation rate; increase in the total number of leukocytes; an increase in the number of leukocytes of a special type responsible for allergic reactions - eosinophils; anemia, decreased hemoglobin content in the blood; an increase in the number of platelets, which indicates an increased tendency to form blood clots.
Blood chemistry	Signs of an autoimmune inflammatory process: violation of the ratio of blood proteins, increase in the relative amount of immunoglobulins - proteins that are antibodies; Most often, the content of immunoglobulins of class A, E, M increases. Detection of rheumatoid factor, a substance that is a marker of rheumatism and other autoimmune diseases.
General urine analysis	For kidney damage: detection of protein in urine; detection of a small number of red blood cells.

Treatment of Wegener's granulomatosis

Medicine	Description	Mode of application
Prednisolone	Hormonal drug (adrenal cortex hormones). It has a pronounced ability to suppress immune reactions, reproduction and functions of immune cells.	During the active phase of the disease, prednisolone is prescribed in maximum dosages. After 1.5 - 2 months, the dosage is reduced, the drug is continued to be taken for 1 - 2 years.
Cyclophosphamide	Cytostatic. Inhibits the reproduction and functions of immune cells.	It is prescribed according to a regimen similar to that of prednisolone. These two drugs are used together.
Azathioprine	Cytostatic. Inhibits the reproduction and function of immune cells. But weaker than cyclophosphamide in this regard.	Can be prescribed when the activity of the process decreases instead of cyclophosphamide.
Plasmapheresis and hemosorption	Special procedures aimed at cleansing the blood of immune complexes and toxins.	Prescribed if drug therapy for Wegener's granulomatosis has no effect.