Vasculitis

With the term Vasculitis describes some autoimmune diseases whose common characteristic is inflamed blood vessels. The symptoms and course of vasculitis can vary greatly depending on the severity of the disease.

What is vasculitis?

A Vasculitis is an inflammation in the blood vessels, which is caused by reactions of the body's own immune system. It can be divided into a group of different autoimmune diseases.

There is primary vasculitis, which includes independent, inflammatory rheumatic diseases. These include large-vessel vasculitis, medium-sized vessel vasculitis, and small-vessel vasculitis.

Secondary vasculitis is also known, which is caused by infections, rheumatic diseases, drugs or other autoimmune diseases. The different forms of vasculitis also differ in terms of their frequency.

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Every year in Germany, up to 20,000 people develop inflammation in the large vessels. Women are more affected than men. Secondary vasculitis is diagnosed in more than 10,000 people in Germany every year.

causes

The causes of a primary Vasculitis are so far unknown. Possible triggers of secondary vasculitis include viral infections, rheumatoid arthritis, malignant tumors, blood and lymph diseases, medications, and the autoimmune disease systemic lupus erythematosus.

A disturbed function of the immune system is important for the causes. Antibodies directed against your own body are responsible for some forms of vasculitis. These autoantibodies can fight against the white blood cells, for example. Immune complexes can also cause vascular inflammation. In this case, the body's own antibodies bind drugs or particles of bacteria and thus create immune complexes which are deposited in the walls of the vessels.

This damages the vessels. For example, hepatitis viruses are found in some variants of this disease. Depending on the severity of the vasculitis, reactions such as vascular occlusion or the formation of aneurysms, granulomas and ulcers are triggered.

Symptoms, ailments & signs

Vasculitis initially leads to unspecific symptoms, which then clearly expand. Above all, a subjective feeling of illness becomes noticeable in the early stages. Those affected are no longer productive in the usual way.

There are also fever and joint problems. Sudden weight loss can occur. The inflammation of the blood vessels expands in a few days to include other complaints - depending on which organ is affected. Pain and signs then appear locally. Patients describe the attack on the heart, kidney, lungs, and nervous system as extremely painful.

Muscle inflammation in the heart can develop, which is accompanied by constant chest pain. There is a risk of functional loss in the kidneys and lungs. People with kidney vasculitis have blood in their urine. If the lung tissue is inflamed, you cough up blood several times a day.

The nervous system becomes paralyzed. Cramps also often set in. The head and the psyche suffer. A stroke is possible. If the skin, the largest organ, is affected, skin reddening and sometimes open skin areas appear. The reduced nutrient and oxygen supply proves its effect here.

Vasculitis causes rheumatic complaints in the muscles. In the stomach, if affected, there is constant abdominal pain. Sometimes there is also inflammation of the blood vessels in the eyes. Then visual disturbances and an attack on the dermis are possible.

Diagnosis & course

If one is suspected Vasculitis different diagnostic methods are available. Laboratory tests are carried out because if a vascular inflammation occurs, the level of white blood cells, the sedimentation rate and the CRP level increase.

Other characteristic blood values ​​can also indicate a certain form of vasculitis. This includes values ​​such as ANCA, complement values ​​and viruses. An important part of the diagnosis is also a sample of the tissue or a biopsy. Depending on the severity of the vascular inflammation, an X-ray vascular imaging can also be used for diagnosis.

If medium and large vessels are diseased, characteristic changes can be detected with the help of X-ray contrast media. How the respective vascular inflammation develops depends crucially on its severity. However, with early diagnosis and consistent therapy, the symptoms of most forms of vasculitis can be alleviated.

Complications

Vasculitis can lead to many different complaints, all of which have a very negative effect on the person's quality of life. The patients suffer from a high fever and also from sweats at night. This also leads to sleep problems, so that most patients suffer from irritability or from depression and other mental disorders.

Furthermore, the disease leads to severe weight loss and severe pain in the joints. A general weakness occurs, so that those affected feel permanently tired and exhausted. The resilience also decreases significantly. Patients are no longer able to perform strenuous physical activity or participate in sports. If vasculitis occurs in a child or adolescent, the disease leads to a significant delay in development.

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As a rule, the symptoms are alleviated with the help of medication, although complete cure of the vasculitis cannot be achieved. There are no further complications. A healthy diet can also have a positive effect on the course of the disease. Whether vasculitis leads to a reduced life expectancy in the patient cannot be universally predicted.

When should you go to the doctor?

With vasculitis, the person concerned is usually always dependent on treatment by a doctor. This disease cannot heal itself, so the person affected should contact a doctor as soon as the first symptoms or signs of the disease appear. Only by starting treatment early can further complications and symptoms be avoided.

A doctor should be contacted for vasculitis if the person has sudden weight loss and a high fever. The symptoms occur for no particular reason and do not go away on their own. Furthermore, severe chest pain can indicate this disease and should also be examined by a doctor. Most patients with vasculitis also have bloody urine or severe cramps in the muscles, which can also cause visual problems.

The vasculitis can be recognized by a general practitioner, whereby the treatment itself is usually carried out by a specialist and depends on the exact severity of the symptoms. Generally, it cannot be predicted whether the affected person will have a reduced life expectancy.

Treatment & Therapy

Treatment of the Vasculitis adapts to the severity and extent of the disease. Often it is not curable, but it can be treated very well. Strong medication is often used for this if the patient's organs or life are threatened. In most cases, cortisone must be taken, the dose of which is slowly reduced.

In addition to this drug, immunosuppressants are often necessary. These are drugs that are supposed to slow down the aggressively working immune system. In severe forms of vasculitis, the immunosuppressive drug cyclophosphamide cannot be avoided. Due to the strength of the drugs, they are usually not taken for more than six months.

The patient then takes less aggressive medication in order to maintain the improved state of health. The many side effects of drug treatment are prevented with the help of urine and blood tests and a conscious diet.

If standard therapy fails, which happens in around 10% of all patients, new approaches to therapy are available. These include TNF blockers. With an early diagnosis, mild courses of vasculitis can be treated with less potent drugs.

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prevention

There are currently no known reliable measures that could Vasculitis could prevent. However, if there is already a vascular inflammation, it is important to identify potential relapses early on. Rapid therapy can thus prevent an unfavorable course. The first warning symptoms of vasculitis include rheumatic symptoms, night sweats, red eyes, and inexplicable weight loss or fever.

Aftercare

Because vasculitis cannot be cured in most cases, but can flare up again and again, extensive follow-up measures are necessary for affected patients, depending on the specific course of the disease and the affected vessels. The core of the aftercare treatment is the administration of anti-inflammatory drugs such as cortisone.

For some time now, so-called biologicals, i.e. modern immunomodulating drugs, have also played an increasingly important role. The aim of this medication in aftercare is to maintain the therapeutic success achieved up to that point and to prevent a possible flare-up of the vasculitis. Depending on the course of therapy, other drugs that suppress the patient's immune system can also be used under close medical supervision.

Depending on the type of vessels affected, follow-up care can also be extended, for example to counteract cardiac diseases. Compression therapy is also used in many cases. Affected patients are then given up on wearing compression stockings. The aim is to improve the blood flow to the vessels, which can have a multiple positive effect on vasculitis.

On the one hand, the compression therapy prevents further deposits from forming on the walls of the vessels. On the other hand, the compression also has a beneficial effect on the healing process in connection with existing foci of inflammation.

You can do that yourself

Depending on the extent and location of the vasculitis, various therapeutic measures are available. Medical treatment, which always includes medication, can be supported by various self-help measures.

Small vessel vasculitis is treated with immunosuppressants, cytostatics, antibodies, and steroids. It is important to note the side effects and interactions in a medication diary and to inform the doctor about the symptoms. In the event of severe side effects, the treatment must be stopped or switched to another preparation. Vasculitis of medium and large vessels may require the use of vascular wall prostheses. Patients are encouraged to rest and rest. Avoid strenuous physical activity, although regular aqua jogging or swimming can aid healing.

In addition, the diet should be changed. An anti-inflammatory menu with vegetable oils, little meat and a protein-rich diet inhibits the spread of internal inflammation. Specific measures apply to special forms of vasculitis. In the case of endangiitis obliterans, nicotine must be avoided. It is also important to be informed about risks such as stroke, heart attack or kidney failure. In the event of a medical emergency, the ambulance service must be called immediately.