Vasculitis is a general term that means inflammation of blood vessels. This inflammation causes a narrowing of the inside of the vessel and can obstruct the flow of blood to the tissues (ischemia). The lack of blood may result in damage to nearby tissues (necrosis), formation of blood clots (thrombosis), and, in rare cases, a weakening or ballooning that may rupture of the vessel wall (aneurysm).
Arteries and veins of all sizes and in all parts of the body may be affected. Vasculitis may be limited to only one location or certain organs (localized or isolated) such as the skin, brain, or specific internal organs. In other cases, vasculitis may affect multiple areas or organs of the body at the same time (systemic or generalized). It may occur alone or as a complication of many other disorders.
The symptoms of vasculitis are many because of the wide variety of body systems it can affect. Depending on the system involved there may be muscle pain, joint pain, fever, weight loss, loss of appetite (anorexia), headache, or generalized weakness. There may also be ulcers of the mouth, hoarseness, night sweats, high blood pressure (hypertension), abdominal pain, diarrhea, blood in the urine (hematuria), or kidney (renal) failure. Eye inflammation and blurred vision are also symptomatic, and in very severe cases blindness can occur. When the respiratory system is involved there may be an inflammation of the sinuses, runny nose, asthma, a cough with or without bleeding (hemoptysis), shortness of breath (dyspnea), nosebleeds (epistaxis), or an inflammation of the membranes of the lungs.
When vasculitis affects the skin there may be lesions that are flat and red (macules), nodules, and hemorrhages under the skin (purpura). These lesions may occur on any area of the body but are seen more frequently on the back, hands, buttocks, the inside area of the forearms and the lower extremities. These skin symptoms may occur only once or at regular intervals. They will usually last for several weeks and may leave darkened spots or scarring. In some cases of vasculitis there may be wheel-like lesions that cause intense itching (urticaria), or ring-shaped lesions and ulcers. Blister-like lesions (vesicles, bullae) may develop in severe cases.
The specific underlying cause of vasculitis is not fully understood. However, in most cases, vasculitis is thought to be due to disturbances of the body’s immune system. Some forms of vasculitis may be due to allergic reactions or hypersensitivity to certain medications such as sulfur drugs, penicillin, propylthiouracil, other drugs, toxins, or other inhaled environmental irritants. Other forms may occur due to fungal, parasitic, or viral infections. In some instances, it is thought that vasculitis may be an autoimmune disorder. Autoimmune disorders are caused when the body’s natural defenses against “foreign” or invading organisms (e.g., antibodies) begin to attack healthy tissue for unknown reasons.
Vasculitis usually affects males and females in equal numbers. It is most commonly seen in the elderly.
There are a large number of disorders that may be characterized by or associated with vasculitis. These disorders are often referred to as the Vasculitic syndromes or vasculitides. (For more information on these disorders, see the Related Disorders section below.)
Because of the wide range of symptoms and body systems involved, an extensive history and physical exam is needed before a clear diagnosis of the type of vasculitis can be made. In some cases, an x-ray of the blood vessels using dye (angiogram), or a biopsy of the affected organ may be recommended to give an accurate diagnosis and to insure proper treatment.
Treatment of vasculitis depends on the cause and symptoms of the underlying disease and the specific organs of the body that are affected. The drugs prednisone, cyclophosphamide, methylprednisolone and pentoxifylline have proven to be successful in treating the autoimmune form of vasculitis. Other treatment is symptomatic and supportive.
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At the present time, research is being conducted on the use of high-dose intravenous gamma-globulin for some forms of vasculitis. Other studies are examining a combination of cytotoxic agents, including cyclophosphamide and steroids, as possible treatments for certain types of vasculitis.
Plasmapheresis may be of benefit in some cases of vasculitis. This procedure is a method for removing unwanted substances (toxins, metabolic substances and plasma parts) from the blood. Blood is removed from the patient and blood cells are separated from plasma. The patient’s plasma is then replaced with other human plasma and the blood is retransfused into the patient. More research must be conducted to determine long-term safety and effectiveness of these drugs and procedures.
Studies are underway to determine the use of monoclonal antibody therapy as a possible treatment for systemic vasculitis in those individuals who are not responsive to immunosuppressive drugs. More research is needed to determine the long-term safety and effectiveness of monoclonal antibody therapy as a treatment for vasculitis.
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