vasculitis - an autoimmune inflammation of the walls of blood vessels.This syndrome may be affected any blood vessels of different caliber: arterioles, veins, arteries, venules, capillaries.Affected vessels can be placed superficially - in the dermis, more deeply - on the border of the dermis and hypodermis, or in any body cavities.
The causes of vasculitis can serve a variety of factors, but most often it is an infectious-allergic agents.With long-term sensitization to any allergen (portrait dust, drugs, pollen, feathers).Or at long flowing infectious process (chronic tonsillitis, otitis, adnexitis, loss of teeth, mycosis).
Some scholars point to a possible provocation of the first symptoms of vasculitis Prolonged exposure to direct sunlight, which are the true paraallergicheskim (promoting sensitization) factor.There are cases of vasculitis appearance after the treatment of tonsillitis, quartz tube in people with a genetic predisposition.
also should pay attention to allergic reactions after the administration of some vaccines, serums.An important place should be given to the exchange of biologically active substances (mediators of inflammation and allergies), as well as all sorts of dysfunction of vascular-platelet and coagulation components of hemostasis.
In establishing the causes of vasculitis, it is necessary to take into account the state of cellular and humoral immunity, since any immune deficiencies can lead to vasculitis.Unfortunately, the exact cause of the aggression to the tissues of the body of the vessel wall is not always possible.
first symptoms of vasculitis characterized by the majority of diseases - namely, weakness, fatigue, a slight increase in numbers of body temperature, headache and muscle pain.However, after some time, the further development of self-aggression of the body, begin to show symptoms of the organ, the vessels which are subject to pathological processes.In many cases, these symptoms can be treated wrongly before the specific diagnosis of vasculitis.
Vasculitis is divided into primary and secondary.
Primary vasculitis - an inflammation of the vessel, which is the reason for the defeat of the organ or tissue that supplies blood vessel.
secondary vasculitis is a consequence of any disease (sarcoidosis, diabetes, systemic lupus erythematosus) and is regarded as a symptom.
In allergic vasculitis of skin appear hemorrhagic spots, nodules, exudative elements with hemorrhagic content.There are no hemorrhagic rash of elements such as erythematous spots, blisters, bubbles.These symptoms make it difficult to diagnose.In the rash can sometimes see black crust - myocardial skin.This symptom is vasculitis creates imaginary resemblance to papules necrotic tuberculosis of the skin.In some patients, a fairly rare manifestation is like bleeding under the toenail.
most common rashes when vasculitis affects the legs, namely: the tibia, dorsum of the foot, hip.In generalized form of vasculitis, even if there are manifestations in the skin of the forearms, torso, it is still the most severely hit by the skin to the lower extremities.
allergic vasculitis, except for the main clinical manifestations, brings a lot of discomfort to patients - joint pain, squeezing or burning pain, rarely - itching at the site of lesions.There have been documented cases of patients' complaints unfounded on joint pain still a few months before the onset of rash.
Allergic knotty vasculitis
This group of vasculitis include acute and chronic erythema nodosum and erythema induratum Bazin.
Acute erythema nodosum different form of inflammatory nodes on the front and back of the leg, the color of the skin on them can vary from bright scarlet to blue and yellow-green (as in resorption of bruising).The nodes are found in different quantities, sizes exceed walnut dense.With typical nodules are rare blisters, papules, patches, but does not occur ulceration, necrosis, scarring.The process ends with complete resorption formations.
Behcet's disease - a nonspecific vasculitis, the cause of which is still unknown.Primarily affecting the mucous membranes of eyes, mouth and skin (usually in the genital area).For this vasculitis characterized by the formation of ulcers and erosions.
Temporal vasculitis - vasculitis, which is accompanied by prolonged headaches in the temples.The most common in older women, hence the second name - senile arteritis (senile disease represents a primary lesion of the elderly).
Systemic vasculitis occurs in connective tissue diseases such as Wegener's granulomatosis, systemic lupus erythematosus, rheumatism.
Vasculitis in Wegener's granulomatosis manifested destructive changes in the walls of vessels of all sizes of the upper and lower respiratory tract, and kidneys.Scientists believe that the disease is triggered by inhalation of a certain specific antigen.The disease runs hard.Patients with ulcerated granulomas appear on the oral mucosa, nasal, bronchial tubes.Against the background of these manifestations of glomerulonephritis occurs, aggravating the severity of the condition.In advanced cases often suffers heart, skin, organs of the nervous system.Diagnosis is based on biopsy with mucosal lesions.
rheumatism Vasculitis is generalized.Severity of symptoms depends on the stage of vasculitis.Typical hemorrhagic rash frequently change location.In addition to skin manifestations of vasculitis in rheumatic disease often affects the blood vessels of vital organs - heart, brain, lung, stomach, esophagus, kidney.With an aggressive course of rheumatic fever, difficult to treat, the possibility of internal bleeding from these vessels.Such effects are often caught unawares patients, may lead to death.Unfortunately, according to statistics, more than half of patients with rheumatism - young woman.
Vasculitis in systemic diseases, such as systemic lupus erythematosus characterized by erythematous rash, follicular hyperkeratosis (thickening of scales epedermisa), atrophy of the skin and the presence of telangiectasia (vascular "stars", disappearing on pressure slides).As for the vessels of the internal organs, they often suffer as a result of the generalization process with low efficiency of hormones.The defeat of the renal vessels, combined with self-aggression to the renal corpuscles, resulting in lupus nephritis.This in some cases lead to severe complications - chronic renal failure.Such patients required hemodialysis and kidney transplantation.
Cerebral vasculitis in patients with systemic lupus erythematosus can cause bleeding under the meninges or the brain.
urticaria vasculitis (synonyms - urticarial vasculitis, urticarial vasculitis dermal) - chronic inflammation of the superficial vessels of the dermis, a type of allergic vasculitis.It flows in waves, often mistaken for chronic urticaria.The characteristic skin manifestations - hemorrhagic spots, nodules, persistent dense blisters, which may persist for three days.These morphological elements are accompanied by unpleasant sensations for the patient - a burning sensation, stretching or skin irritation, as well as joint pain.
not ruled out a number of common symptoms - rise in temperature of up to 1 - 1,5˚S, weakness, headache, irritability, muscle pain, abdominal pain, low back.A detailed study in patients with glomerulonephritis can be detected, indicating that the generalization of the process.In some cases, patients complained of severe abdominal pain pristupopodobnye not having a clear position, as well as a liquid "black" chair.This may indicate hypersensitivity vasculitis during a tendency to generalization.
diagnosis of vasculitis in this embodiment, the flow is based on immunofluorescence methods of research, as well as histological examination of the affected area of the skin.Histologically visible friable, edematous, sometimes necrotic blood vessels, areas of tissue soaked with blood plasma.In the course of the vessel extend vospalitelnokletochnye infiltrates areas like penetrating the vessel wall.
scientists found connection with the process of mast cells of allergic inflammatory vascular lesions.These cells produce and accumulate biologically active substances - histamine, serotonin, heparin, hyaluronic acid.Consequently, when thorough biochemical and clinical blood test can reveal a significant increase in performance of basophils, eosinophils, and biologically active substances.
Note that even cutaneous vasculitis may acquire a systemic nature and cause heavy damage to the health of many organs.
Vasculitis in children
Vasculitis occur in childhood is rare, but they only have the characteristic features of the course.
Kawasaki syndrome - mainly vascular lesions of small and medium diameter with the further development of destructive or destructive-proliferative vasculitis.It occurs in children up to 7 years.The disease is systemic in nature, affecting the coronary vessels of the heart, the mucosa of the upper and lower respiratory tract, lymph nodes.It has a sharp, rapid start with a significant rise in temperature to high (38 ° C) and even up to very high (41oS) digits.
Amid prolonged debilitating symptoms of fever, skin lesions in the form of polymorphic purpura (scarlatiniform rash erythematous plaques) and mucous membranes of the respiratory tract, eyes, nose, making it very difficult diagnosis of vasculitis.
With the passage of time (1-3 days) begins redness and thickening of the skin on the palms and soles, which limits the mobility of the small joints of the sharp pain.Against the background of these phenomena are increased cervical lymph nodes, language becomes crimson.Two weeks after the onset of the disease begins okolonogtevogo krupnoplastinchatoe peeling on the phalanges of the fingers or toes.In some cases the exfoliation extends over the whole finger.The defeat of the cardiovascular system accompanies the acute phase of the disease, the most dangerous complication is coronary artery aneurysms can lead to myocardial infarction and death.Among the more rare lesions of the internal organs should be noted meningeal syndrome, damage the gastrointestinal tract, liver and spleen, the most rare kidney damage.With timely diagnosis, Kawasaki syndrome fails to heal, and the consequences may regress within 5-8 years.
hemorrhagic vasculitis in children are divided into several forms, depending on the predominant symptoms of organs and tissues.Namely: skin, skin and joints, abdominal, kidney and skin and kidney shaped.Cutaneous can be simple, necrotic or be accompanied by cold urticaria with severe edema.Simple cutaneous vasculitis characterized by a skin rash in the form of hemorrhagic purpura, which slightly rises above the healthy skin.Initially localized rashes on his legs, gradually spreading over the inner thighs.
to skin syndrome gradually joins the joint.In a migratory pain in large joints of the lower limbs, at least in the elbow and shoulder joints.In children, pain in the joints occur before the appearance of new lesions on the skin.Abdominal form is characterized by more severe with severe abdominal pain.Children often point to the localization of the pain around the navel.
Sometimes abdominal form of vasculitis accompanied by gastrointestinal bleeding.In most cases, the bleeding is not abundant and are not life threatening.Among the possible complications - peritonitis, perforation, intussusception.In renal form of pathological changes manifest themselves in 2 or 3 weeks after the onset of the disease.Often, kidney damage is fixed with urine microscopy.Identified proteins, globulins.Normally, when a timely adequate therapy, the changes in the indicators disappear.But in rare cases, doctors have to deal with glomerulonephritis or nephrotic syndrome.Lung damage, nervous system hemorrhagic vasculitis in children are described in isolated cases.A common feature of different forms of this disease is the tendency to generalize and recurrent stream.
Another type of systemic vasculitis in children, it periarteritis nodosa.It is one of the most severe forms of angiitis.The scientists found that almost 30% of patients in the blood has a surface marker of hepatitis B. The main symptoms - high fever that does not respond to antibiotics and antipyretics (only sensitive to glucocorticoids), rapid weight loss, frequent thrombosis of small arteries, which leadsto ischemia and tissue necrosis.Chance of necrosis of the toes, heart attacks internal organs.
disease can bring a lot of complications - arterial hypertension, nephrotic syndrome, acute heart failure, vascular pleuropneumonia resistant asthma xanthines.The characteristic skin manifestations are: marbling of the skin or the so-called livedo (manifestations in the course of the vessel branches as branches of a tree), subcutaneous nodules along the vessels and painful swelling of the limbs.The symptom "bleeding Node" (described by Professor Romanenko) is found exclusively in the nodular periarteritis - regardless of injury or physical exertion of the assembly opens the bleeding, which may last up to three days.Tromboangitichesky syndrome exhibit a strong pain on zatrombirovannoy arteries, which are enhanced at night, exhausting child sleepless nights.
Later appears lividity of the skin, cooling, decrease in sensitivity, swelling, feeling of "pins and needles."If adequate treatment is not assigned, then joined in the background of a bacterial infection develops gangrene.This process usually ends limb amputation.But if attempts have been made adequate therapy, the ischemia persists, that will keep the limb.
Other symptoms of vasculitis, it should be noted ephemeral limited swelling and telangiectasia (spider veins).Appear on the face, upper or lower extremities.Have the form of a bracelet or a pillow.May be interpreted incorrectly and be confused with urticaria, angioedema.Suddenly and disappear without a trace.Even if there are clear signs pointing to periarteritis nodosa, diagnosis exhibited the results of histopathological examination of the material biopsies of lesions.
Another complex form of systemic vasculitis - a non-specific aortoarteriit.It affects the aorta - the main trunk vessel.Depending on the location of the lesion secrete several forms of the disease: the defeat of the aortic arch and exhaust its branches, the defeat of the descending aorta, mixed defeated arch, thoracic and abdominal parts of it, as well as the variant destruction of any part of the aorta, combined with the defeat of the pulmonary artery.The disease develops slowly.
characteristic for this type of vasculitis symptoms - lack or asymmetry of the pulse in the upper limbs may be missing at the beginning of the disease.For each type of vasculitis can be identified leading symptoms.