Sequelae of vasculitis. Vasculitis of medium-sized vessels. Diagnosis of systemic vascular disease

This term combines a number of diseases accompanied by inflammation of the vascular walls. For such pathologies, narrowing of blood vessels is characteristic, due to which there is a deterioration in nutrition and oxygen supply to tissues. This is dangerous by disrupting the work of individual organs up to their complete failure, which leads to disability and even death. Vasculitis is still not fully understood, so doctors do not isolate exact reasons development and methods of treatment of the disease. Therapy of such pathologies is carried out by rheumatologists, and sometimes by infectious disease specialists and dermatologists.

What is vasculitis

A group of autoimmune processes in which inflammation of the arterial or venous walls of human blood vessels occurs is vasculitis. Progressing, the disease disrupts blood flow to some organs, which is fraught with the development of their complications. Based on the cause of development, vasculitis is divided into the following types:

Primary. Their etiology has not yet been elucidated, but trigger factor considered an autoimmune disorder.
Secondary. Develop against the background of other diseases - acute or chronic.

These factors, and especially the combination of several at once, can change antigenic structure own walls of blood vessels. As a result, the immune system begins to perceive them as foreign. For this reason, the production of antibodies begins, damaging the vascular walls. This phenomenon triggers inflammatory and degenerative processes in target tissues. Secondary vasculitis is not only immunological disorders. Possible causes of vascular inflammation include the following:

injury different localization and genesis;
skin burns, including solar ones;
overheating or hypothermia of the body;
individual reaction of the body to vaccines or drugs;
contact with biological poisons or chemicals;
hereditary predisposition;
transferred viral hepatitis;
long fungal diseases including candidiasis.

signs

Vasculitis has many varieties, so the clinical picture and the severity of symptoms of a particular form of the disease may differ. A typical symptom is hemorrhage small area with primary localization on the skin of different parts of the body. With the progression of the disease, they appear in muscle tissue, areas of nerve endings and joint cavities. Doctors identify several other common features, which indicate inflammation of the vascular walls:

decreased visual acuity;
bloody stool;
stomach ache;
joint pain, arthritis;
rash;
heat, headache;
weight loss;
sleep disorders;
prolonged bronchitis, eosinophilic pneumonia, bronchial asthma;
headache;
pleurisy;
neuropsychiatric disorders;
seizures;
fluctuations in psycho-emotional state;
pale skin;
periodic loss of consciousness;
nausea, vomiting;
swelling in the temporal region.

Vasculitis classification

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

Capillary. It consists in the defeat of small vessels (capillaries). In this case, there may be: Dego's disease, urticarial vasculitis (urticaria), Schamberg's pigmentary purpura, Wegener's granulomatosis.
Arteriolitis. It is an inflammation of medium-sized vessels (arteries and arterioles). It is manifested by lepromatous arteritis, polyarteritis nodosa, Kawasaki disease, familial Mediterranean fever, striatal vasculopathy.
Arteritis. This is a lesion of large vessels (artery walls). These include giant cell arteritis, Takayasu's disease, Cogan's syndrome, sarcoidosis, and tropical aortitis.
Phlebitis. In this form of vasculitis, the walls of the veins become inflamed.
Vasculopathy. With this disease, there are no clear signs of inflammatory cell infiltration. vascular wall.

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

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

neurovasculitis

Under the influence of cold or nerves, neurovasculitis may develop. This disease is a reversible inflammation of the vessels of the extremities associated with a disorder of reflex neurogenic reactions to irritation. The reason is the regular effect of temperatures in the range from -2 to +12 degrees against the background of high humidity or a single frostbite.

Neurovasculitis occurs in adults over 25 years of age who work in damp, cold environments. Depending on the stage of the disease, a person has the following symptoms:

First. It is accompanied by chilliness of the feet, pallor and cyanosis, but without swelling of the extremities.
Second. At the end of the working day, edema appears, cyanosis and hyperesthesia of the skin, pain in the feet during compression are noted.
Third. Edema at this stage does not go away, the pain becomes burning, ulcers develop, ascending thrombophlebitis.

rheumatic vasculitis

This is one of the varieties of rheumatoid arthritis. The mechanism of development of rheumatic vasculitis is associated with immune processes that are involved in the development of arthritis. In almost all patients, such vascular inflammation is accompanied by general inflammatory manifestations: fever, severe weight loss. Clinical manifestations of rheumatoid arthritis are included in the group of extra-articular symptoms of rheumatoid arthritis. These include the following signs:

peripheral gangrene;
scleritis;
mononeuritis;
pericarditis;
disruption of the lungs;
damage to the skin of the periungual bed.

perivasculitis

All vasculitis are classified into types depending on the location of the inflammation. If the inner vascular layer is affected, then this is endovasculitis, if the middle layer is mesovasculitis. When the tissues adjacent to the blood vessel become inflamed, the disease is called perivasculitis. With it, the arterial wall is completely destroyed. As a result, it ruptures, inflammation of the outer layer of blood vessels begins and connective tissue.

As the disease progresses, it can lead to gangrene or necrosis. The most common type of perivasculitis is polyarteritis nodosa. It affects the following small and medium-sized vessels:

brain;
renal;
hepatic;
coronary;
mesenteric.

autoimmune vasculitis

This type of vasculitis has many different causes. One of the provoking factors is genetic predisposition. Vessels of certain sizes are affected by different types of autoimmune vasculitis:

large - giant cell and Takayasu's arteritis;
medium - nodular and microscopic polyarteritis, Kawasaki disease, Wegener's disease, Behcet's disease.

The clinical picture is determined by the type of autoimmune vasculitis. Primary signs are manifested in skin lesions: its sensitivity increases or decreases. Against this background, there are: incomplete paralysis of the arms and legs, insomnia, syndrome chronic fatigue, fever, poor appetite. The disease is characterized by an undulating course, i.e. periods of remission are replaced by exacerbations. The latter occur mainly in the cold season. Depending on the type of disease, a person may experience the following symptoms of vasculitis:

Hematological. Causes chest pain, cough with copious sputum, shortness of breath, weakness, kidney failure.
Rheumatoid. Accompanied by pain in the limbs, fainting, mental disorders. May lead to stroke.
Arteritis Takayasu. It is noted mainly in women 15-20 years old. Symptoms of the disease: fever, headache, dizziness, weight loss. After 5-10 years, pathology can lead to a heart attack.
Wegener's disease. It is indicated by cough, shortness of breath, prolonged rhinitis, sinusitis or sinusitis, runny nose and discharge of mucus from the nose with blood impurities, deformity of the saddle and nasal septum, impaired renal function, protrusion eyeballs. Half of patients develop conjunctivitis or ischemia optic nerve.
Behçet's disease. Accompanied by stomatitis, ulcers and erosions on the genitals, inflammation of the eyes.

Hemorrhagic vasculitis

This type of vascular inflammation is more common in children than in adults. Boys aged 4-12 are especially prone to developing this disease. Pathology is an aseptic (non-infectious) inflammation of the capillaries caused by the damaging effect of immune complexes. The main signs of the disease are hemorrhages (hemorrhages), disorders of blood circulation in small vessels and a violation of its intravascular coagulability. Depending on the clinical course pathology is:

renal;
abdominal (from the side of the abdomen);
skin;
articular;
combined.

The disease often develops after influenza, acute tonsillitis or scarlet fever. The causes may also be drug allergies, hypothermia, genetic predisposition. The hallmarks of hemorrhagic vasculitis are:

purple rash on the legs, knees, hands, or abdomen;
pain in the ankle joints, leading to difficulty in motor function;
stomach ache;
kidney damage.

Allergic

The main cause of this type of vascular inflammation is an allergy to various external or internal factors: regular medication (sulfonamides, barbiturates, analgesics), chemical products, infections. Because of their reactions immune system allergic vasculitis develops. It often proceeds without the involvement of internal organs in the pathological process. Depending on the caliber of the affected vessels, allergic vasculitis is divided into the following types:

Surface. It affects small venules and arteries of the skin, capillaries. Inflammation is manifested by hemosiderosis, Ruther's allergic arteriolitis, nodular necrotizing vasculitis.
Deep. The pathological process involves arteries and veins of medium and large caliber located in the subcutaneous fat and on its border with the dermis. Pathology is manifested by acute and chronic erythema nodosum.

necrotizing

This type of disease is rare, especially in children. Pathology is accompanied by extensive skin necrosis, fever, chills, weight loss and fatigue. Sometimes there is an increase cervical lymph nodes, bilateral purulent conjunctivitis, swelling of the hand and feet. Necrotizing vasculitis develops more often as a complication of other forms of this disease. The following signs are observed on the skin:

small papules on the skin - each vesicle with transparent contents;
redness of the skin;
blue fingers or toes;
non-healing wounds and ulcers;
joint pain;
numbness, tingling in the limbs;
speech disorders;
blood in urine or stool.

Diagnostics

The first step in the diagnosis of the disease is a careful examination of the patient by a doctor. The difficulty lies in the fact that not all patients immediately turn to a rheumatologist, and the disease sometimes goes into remission, which creates the illusion of recovery. If vasculitis is suspected, the doctor prescribes a number of laboratory, instrumental and morphological studies:

Serological. Blood is examined for antineutrophil cytoplasmic antibodies, which helps to identify microscopic polyangiitis, Wegener's granulomatosis, Churg-Strauss syndrome. Additionally, they are examined for rheumatoid factor to rule out rheumatic disease and cryoglobulins to differentiate vascular inflammation from Goodpasture's syndrome.
Visceral angiography. Before the procedure, a contrast agent is injected intravenously to study the blood flow through the vessels. The study itself is carried out using x-rays.
Doppler ultrasound. This procedure evaluates the intensity of blood flow in the vessels, which makes it possible to judge its violations.
Computed and magnetic resonance imaging. They help to visualize changes in the structure of internal organs.
An extended blood test. Inflammation is indicated by an increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes.
Analysis of urine. Pathology is confirmed by the excess in urine of the normal amount of C-reactive protein and the presence of blood elements.
Aortography. This is an x-ray examination of the aorta based on image acquisition after it has been filled with a contrast agent.

Vasculitis treatment

The goal of treating the disease is to reduce the aggression of the person's own immune system. This is necessary to achieve remission and prevent subsequent relapses. Additionally, measures are taken to prevent irreversible damage to tissues and organs. In general, the treatment regimen includes the following activities:

Taking medication. The patient is shown drugs that reduce the synthesis of antibodies and tissue sensitivity. Abnormal activity of the immune system is suppressed with the help of glucocorticoids. If they do not give an effect, then chemotherapy with the use of cytostatics is used. With their use, the prognosis is favorable: 90% of patients live after treatment with these drugs for more than 5 years. With the bacterial nature of the disease, the patient is prescribed antibiotics. In mild cases, non-steroidal anti-inflammatory drugs are indicated.
Carrying out extracorporeal hemocorrection. This includes blood purification techniques, such as hemosorption, plasmapheresis, immunosorption.
Diet food. The diet is selected taking into account the reasons that led to inflammation of the vessels. Additionally, the possibility of developing allergies is excluded. The patient must follow the diet during the exacerbation and for some time after it.

During the acute stage, the patient is shown bed rest. This contributes to the disappearance of the rash on the skin and the stabilization of blood circulation. A week after the appearance of the first rashes, a gradual expansion of the regimen begins. Treatment can be done at home or in a hospital. The main indications for hospitalization are moderate and severe forms of the disease. Therapy in the hospital is also necessary in the following cases:

hemorrhagic form of the disease;
the development of vascular inflammation during pregnancy;
exacerbation of the disease or its appearance for the first time;
childhood.

Medical therapy

Certain drugs for vasculitis are prescribed only by a doctor, taking into account the severity of the disease and the patient's examination data. With a recurrent form of the disease, drugs have to be taken in courses of 4-6 months . With a mild course, the treatment lasts 8-12 weeks, with a moderate course - about a year. Depending on the form of the pathology, the doctor may prescribe the following groups of drugs:

Non-steroidal anti-inflammatory drugs: Ortofen, Piroxicam. They relieve joint pain, reduce swelling and the severity of skin rashes.
Antiplatelet agents: Aspirin, Curantil. They thin the blood by inhibiting the adhesion of platelets, which helps prevent the formation of blood clots.
Glucocorticosteroids: Prednisolone. It is a first-line drug of choice that has an immunosuppressive effect. Additionally, Prednisolone has a pronounced anti-inflammatory effect, therefore it is necessarily prescribed for severe disease.
Anticoagulants: Heparin. By slowing down blood clotting, the risk of developing blood clots is eliminated.
Cytostatics: Azathioprine. They are prescribed for the ineffectiveness of corticosteroids, the presence of contraindications to their use, or the rapid progression of the pathology. The function of Azathioprine is the suppression of cellular immunity reactions.
Enterosorbents: Nutriclinz, Thioverol. Bind and remove toxins from the body formed during the illness.
Antihistamines: Suprastin, Tavegil. Their intake is rational only at the initial stage of the disease in children if they have food or drug allergies.

Gravitational blood surgery

This method of treatment includes methods of cleansing the blood of substances that cause the disease or aggravate its course. Among these procedures are the following:

Immunosorption. It involves passing venous blood through an apparatus filled with immunosorbent. This is a special drug that binds antibodies and immune complexes that damage blood vessels.
Hemosorption. Blood is passed through an apparatus with a sorbent, which also purifies it of antibodies, immune complexes and antibodies. It helps to get rid of toxins, stimulate blood circulation and improve tissue nutrition.
Plasmapheresis. Blood from a peripheral vein is passed through a centrifuge, where the fluid is separated into red blood cells and plasma. The blood cells are then returned to bloodstream with donor plasma or plasma-substituting solutions. This removes antibodies, antigens and immune complexes from the blood.

Diet food

The diet for vasculitis should be hypoallergenic. This is necessary to exclude factors that provoke inflammation of the vessels. The patient should give up fried foods and switch to stews. In the menu, it is recommended to enter fresh fruits and vegetables, dairy products, dried fruits and cereals. The following foods should be removed from the diet:

citrus fruits - tangerines, oranges, lemons;
red apples, strawberries, strawberries;
sweet pastries;
eggs;
salty dishes;
alcohol;
strong tea;
coffee, chocolate;
chips, crackers, flavor enhancers;
honey, pollen;
mushrooms;
industrial cans.

Prevention of vasculitis

Since the primary form of the disease does not have a well-defined cause, its prevention is difficult. In this case, it is only rational to strengthen the immune system by taking immunomodulating drugs. Additionally, it is necessary to harden the body with cold douches, swimming, winter swimming. Helps strengthen the immune system and proper nutrition combined with regular physical activity.

Prevention of the secondary form of the disease has more principles. It is important to exclude from your life the factors that are the causes of vasculitis. With this in mind, you need to follow following recommendations:

exclude prolonged stress;
reorganize chronic foci infections;
eat properly;
observe the sleep and rest regimen;
to not allow long-acting on the body of allergens and environmental factors associated with occupational hazards.

Video

Systemic aseptic inflammation of the vessels of the microvasculature with a primary lesion of the skin, joints, gastrointestinal tract and renal glomeruli. It occurs with symptoms of hemorrhagic or urticarial rash, arthralgia, abdominal pain syndrome, hematuria and renal failure. Diagnosis is based on clinical symptoms, laboratory data (blood, urine, coagulogram), examination of the gastrointestinal tract and kidneys. The basis of the treatment of vasculitis is therapy with anticoagulants, angioplatelet agents. AT severe cases extracorporeal hemocorrection, glucocorticoid therapy, anti-inflammatory, cytostatic treatment are used.

Complications

Kidney damage is the most persistent syndrome of hemorrhagic vasculitis, which can be complicated by malignant glomerulonephritis and chronic renal failure. In severe cases of allergic purpura, gastrointestinal bleeding occurs, accompanied by hematemesis and the presence of blood in the feces, pulmonary hemorrhages, hemorrhages in the substance of the brain (hemorrhagic stroke). Massive blood loss can lead to collapse and anemic coma. Complications of the abdominal syndrome are less common and are represented by intestinal invagination, peritonitis, thrombosis of the mesenteric vessels, necrosis of the part small intestine. The highest frequency of deaths is recorded in the fulminant form of hepatitis B.

Diagnostics

Treatment

In the acute phase of hemorrhagic vasculitis, patients should follow bed rest and a hypoallergenic diet, limit fluid and salt intake, and exclude antibiotics and other medications that can increase body sensitization. The main directions of therapy depend on clinical manifestations, so it is advisable to consider them syndromically:

For any syndrome. basis basic therapy in all forms of HB is the appointment of antiplatelet agents (dipyridamole, pentoxifylline) and fibrinolysis activators (nicotinic acid). The drugs of these groups prevent platelet aggregation, improve microcirculation and interstitial perfusion. Often, heparin and other anticoagulants are included in the basic regimen.
With skin syndrome. Therapy involves the use of sulfasalazine, colchicine. The use of prednisolone is still controversial issue among doctors. Perhaps his appointment in severe cases of GV. In the absence of the effect of corticosteroid therapy, cytostatics are the reserve drugs.
With articular syndrome. Severe arthralgias are stopped by anti-inflammatory therapy (indomethacin, ibuprofen). Additionally, aminoquinoline derivatives (chloroquine) may be prescribed.
With renal syndrome. High doses of glucocorticoids, cytostatics are prescribed. It is possible to use ACE inhibitors, angiotensin II receptor antagonists, the introduction of a normal human immunoglobulin, conducting electrophoresis with nicotinic acid and heparin on the kidney area. End-stage CKD requires hemodialysis or kidney transplantation.
With abdominal syndrome. Intensive pain syndrome serves as an indication for intravenous administration of prednisolone, rheopolyglucin, crystalloids. With the development of surgical complications (perforation, invagination of the intestine), surgical tactics are used.

Severe course disease is an indication for extracorporeal hemocorrection (hemosorption, immunosorption,). Many authors note the ineffectiveness of antihistamines in the treatment of hepatitis B. However, their use may be justified in patients with an allergic history. When the disease is associated with food allergies and the presence of abdominal syndrome, enterosorbents are additionally prescribed.

Forecast and prevention

Mild forms of hemorrhagic vasculitis are prone to spontaneous healing after the first attack of the disease - their prognosis is favorable. With a fulminant form, the death of patients can occur in the first few days from the onset of the disease. Most often this is associated with damage to the vessels of the central nervous system and the occurrence of intracerebral hemorrhage. another reason lethal outcome can become a severe renal syndrome, leading to the development of uremia. In order to prevent allergic vasculitis, it is recommended to sanitize chronic infectious foci of ENT organs, deworming in case of helminthic infestations, exclusion of contact with known allergens and uncontrolled medication.

Vasculitis is an autoimmune inflammation of the vessel wall. With this syndrome, any vessels of different calibers can be affected: arterioles, veins, arteries, venules, capillaries. Affected vessels can be located superficially - in the dermis, more deeply - at the border of the dermis and hypodermis, or in any body cavities.

Vasculitis causes

Various factors can serve as the causes of vasculitis, but most often these are infectious-allergic agents. With prolonged sensitization of the body by any allergen (book dust, medications, plant pollen, down). Or with a long-term infectious process ( chronic tonsillitis, otitis, adnexitis, damage to the teeth, fungal infections).

Some scientists point to the possible provocation of the first symptoms of vasculitis by prolonged exposure to direct sunlight, which is a sure para-allergic (allergenic) factor. There are cases of the appearance of vasculitis after the treatment of tonsillitis with tubus-quartz in people with a hereditary predisposition.

In addition, attention should be paid to allergic manifestations after the introduction of certain vaccines, sera. A significant place should be given to the exchange of biologically active substances(mediators of inflammation and allergy), as well as all sorts of violations functions of the vascular-platelet and coagulation component of hemostasis.

When establishing the causes of vasculitis, it is necessary to take into account the state of the cellular and humoral immunity, because any immunodeficiency state can lead to vasculitis. Unfortunately, it is not always possible to accurately establish the causes of the body's aggression towards the tissues of the vessel walls.

Vasculitis symptoms

The first symptoms of vasculitis are characteristic of most diseases, namely weakness, fatigue, a slight increase in body temperature, headache and muscle pain. However, after some time, with the further development of auto-aggression of the body, symptoms of damage to the organ, the vessels of which are subject to the pathological process, begin to appear. In many cases, these symptoms may be misinterpreted prior to a specific diagnosis of vasculitis.

Vasculitis is divided into primary and secondary.

Primary vasculitis is an inflammation of a vessel that causes damage to an organ or tissue supplied with blood by this vessel.

Secondary vasculitis is a consequence of any disease (, systemic) and is considered as a symptom.

With allergic vasculitis of the skin, hemorrhagic spots, nodules, exudative elements with hemorrhagic contents appear. Rashes without hemorrhagic elements are possible, such as erythematous spots, blisters, vesicles. Such manifestations greatly complicate the diagnosis. In the area of rashes, you can sometimes see a black crust - a skin infarction. This symptom of vasculitis creates an imaginary resemblance to papulo-necrotic tuberculosis of the skin. In some patients, such a manifestation as hemorrhages under the toenails is quite rare.

Most often, rashes with vasculitis affect the legs, namely: the legs, the back of the feet, and the thighs. With a generalized form of vasculitis, even if there are manifestations on the skin of the forearms, torso, the skin of the lower extremities will still be most affected.

Allergic vasculitis, in addition to the main clinical manifestations, brings many discomfort- pain in the joints, squeezing or burning pain, less often - itching at the site of the rash. Cases of patients complaining of unreasonable pain in the joints were recorded several months before the appearance of the first rashes.

Allergic nodular vasculitis

This group of vasculitis includes acute and chronic erythema nodosum and Bazin's indurative erythema.

Acute erythema nodosum differs in the formation of inflammatory nodes on the anterior and posterior surfaces of the legs, the color of the skin over them can vary from bright scarlet to blue and yellowish-green (as in the resorption of a bruise). Nodes meet at different amount, may be larger than Walnut, dense. With typical nodules, blisters, papules, and spots are rare, but ulceration, necrosis, and scarring are not found. The process ends with complete resorption of the formations.

Patients with vasculitis with tuberculous allergy are prescribed a consultation with a phthisiatrician, Rifampicin, Ftivazid.

With severe skin or skin-articular syndrome, non-steroidal anti-inflammatory drugs are widely used for 7 days with a break of 5 days - Reopirin, Pirabutol 0.025 g after each meal; Mefenamic acid up to 0.5 g three times a day; Indomethacin or Ibuprofen twice after each meal. According to indications, 5-7 courses are carried out.

To restore the elasticity and strength of the vascular wall, Ascorbic acid 5 ml is used - a 5% solution intravenously for 3-4 weeks; Rutin inside 0.005 g after breakfast, lunch and dinner. After - a dragee inside of 0.3 g 3 times a day. These medical preparations can be replaced by herbal remedies - infusion of rose hips, decoction of red and black currant leaves, infusion of mountain ash, nettle.

The use of antioxidants, for example, Retinol, is shown.

For headaches and joint pain, thiamine bromide is prescribed at 2 ml - 3% intramuscularly every other day for no more than a month. With metabolic changes in the heart muscle, according to ECG indications, vitamin B-12 is used in combination with Riboxin 2 tabs 2-3 times a day.

Multivitamins - "Stresstab", "Multivit", "Unicap", "Supradin" - 1 tablet per day.

Interferon inducers are prescribed - Cycloferon, Neovir, Amizon, Amiksin. These drugs have an antiviral effect, improve the immune system. Courses - 5-9 days, 5 courses in total.

Non-specific immunotherapy - Methyluracil 0.5 g up to four times a day, in combination with topical application.

With extensive edema, hemorrhagic necrosis - Neogemodez 200-400 ml + Prednisolone 30 mg + Vitamin C 10 ml - 5% solution for intravenous administration at a rate of 40 - 60 drops per minute, 2-3 times a week. The use of such a "mixture" of corticosteroids avoids many of the side effects that occur when taken orally.

new promising direction in the treatment of vasculitis is the use of polyenzymes - medical complexes for oral administration: Wobenzym 15-18 AMD per day and Phlogenzym 6-9 AMD per day for 1-2 months.

To reduce the inflammatory process, Parmidine, Pyridinocarbamate, Phenylbutazole are used in the form of a 5% ointment.

Physiotherapeutic procedures for vasculitis - UVI in erythemal doses of 10-15 minutes daily. Phonophoresis of anti-inflammatory drugs.

Therapy of vasculitis should be strictly individual and approved by doctors of different specialties.

The diet of patients should include foods containing a large amount of protein, carbohydrates, vitamin C, R.

External treatment of vasculitis is indicated in the presence of ulceration, foci of necrosis. Ointments of 5-10% Methyluracil, Levosin, Troxevasin, Propoceum are used.

Vasculitis is a group of various diseases, the pathogenesis of which is damage to the walls of blood vessels with subsequent involvement of various organs and systems in the pathological process. Vasculitis can be primary or secondary. Primary vasculitis are independent diseases belonging to the group of rheumatic diseases. Secondary vasculitis occurs as a complication of various systemic diseases.

Causes of primary vasculitis

Primary vasculitis is a group of various diseases, so it is rather difficult to talk about specific causes. In most cases, the cause remains unknown. Provoking factors that trigger inflammatory process in vessels are considered:

various infections. Quite often, one can trace the development of vasculitis after infectious diseases caused by various streptococci, staphylococci, Yersinia and other bacteria, hepatitis B and C with the detection of viral antigens in the wall of the affected vessels.
Reception of various medicines. Currently, more than a hundred medications have been identified, the use of which can provoke the development of vasculitis. Among the most common are antibacterial drugs, analgesics, vitamins, radiopaque substances.
Cases of development of vasculitis after vaccination are known.
Role not fully explored genetic predisposition to the occurrence of systemic vasculitis due to a defect in the immune response or a change in the reactivity of the vessel walls.

Symptoms of vasculitis

In primary vasculitis, the pathological process develops in the walls of the vessels, and the symptoms depend on the level of the lesion. circulatory system. Both the aorta and large main vessels, as well as the smallest capillaries, can be involved in inflammation. This explains the variety of complaints and clinical manifestations and makes it difficult to diagnose the disease.

Common symptoms include:

Rapid fatigue.
Headache.
General weakness.
Decreased appetite and weight loss.
An increase in body temperature to subfebrile numbers for a long time, which does not decrease while taking antibacterial drugs.

Most vasculitis is characterized by skin lesions. Clinical manifestations of diseases are polymorphic, depending on the severity of the process, the caliber of the affected vessels, and their localization. Spots, petechiae, purpura, ecchymosis, livedo reticularis may appear on the skin. At advanced stages trophic ulcers may appear, deep, painless, with scanty discharge. Healing of ulcers is more dependent on the adequacy of therapy systemic disease than from topical therapy.

Joint damage is a common symptom, patients have a pronounced pain syndrome, without loss of functionality of the affected limbs.

Pain in the muscles due to a violation of their blood supply. Severe pain syndrome may precede a violation of the peripheral nervous system, which will manifest itself in a decrease in the sensitivity of the tips of the fingers and toes.

Prognostically unfavorable syndrome - kidney damage occurs in 20 - 30% of patients and indicates a far advanced process.

A photo. Vasculitis on the body and hands

Diagnosis of vasculitis

There are no specific laboratory tests to confirm the diagnosis of vasculitis. Important role in the diagnosis has a clinical picture of the disease, that is, the sequence of appearance and severity individual symptoms, as well as changes revealed during an objective examination of the patient. Great importance have the gender and age of the patient. Laboratory indicators characterize the activity of the pathological process (severity of leukocytosis, ESR, the presence of rheumatoid factor, immunoglobulins). An important role in vasculitis has a biopsy of the affected tissues. For specific forms of vasculitis, there are own criteria for assessing the features of the clinical picture and laboratory parameters.

Hemorrhagic vasculitis characterized by damage to small vessels, develops mainly in children and adolescents. AT clinical picture there is damage to the skin, joints, intestines and kidneys. Skin rashes are small subcutaneous hemorrhages (purpura), localized on the legs. The main danger of this disease is kidney damage, which can occur long time asymptomatic and lead to renal failure.

Arteritis Takayasu associated with damage to the aorta and its branches, while in the vessels there are areas of narrowing, alternating with local expansions. Mostly young women are affected. Symptoms are associated with the presence of an inflammatory process and insufficient blood supply to vital organs. High risk of serious complications: stroke, myocardial infarction, renal failure.

Horton's arteritis (temporal, senile arteritis) . Also affected large arteries, but this type of lesion is more localized. Branches are most commonly affected. carotid artery, the most typical lesion of the temporal artery. It is observed in women after 60 years. High risk of stroke, vision loss.

Polyarteritis nodosa . develops more often in young men, is associated with hepatitis B infection. Small and medium-sized arteries are affected with the formation of many aneurysms. Characteristic high fever, severe pain in muscles, joint pain, rapid weight loss, kidney damage.

Cryoglobulinemic vasculitis associated with long-term infection with hepatitis C. Women over the age of 30 suffer.

Treatment of vasculitis

Drug therapy of systemic vasculitis is primarily aimed at suppressing autoimmune inflammation, strengthening the vascular wall, improving blood circulation and blood clotting.

The mainstay of treatment for most systemic vasculitis is anti-inflammatory hormonal therapy and immunosuppression. The drugs of choice for anti-inflammatory treatment are hormonal glucocorticoids - prednisolone and methylprednisolone. Their action is based on the mechanism of suppression of the formation of inflammatory factors, a decrease in the production of antibodies to one's own tissues. In severe cases of the disease, treatment begins with intravenous administration of high doses of prednisone. Droppers are prescribed for 3-5 days, followed by a transition to tablet forms and a gradual decrease in the dose to a maintenance one. It is not recommended to independently adjust the dose of prednisolone or stop taking the drug due to the risk of side effects. This can lead to an exacerbation and nullify all the results achieved.

Cytostatics (cyclophosphamide, methotrexate, azathioprine) are used to suppress the activity of the immune system. With excessive severity of the inflammatory reaction, therapy begins with the drug cyclophosphamide (cyclophosphamide), its therapeutic effect based on a decrease in B and T-lymphocytes, which reduces the number of autoantibodies. When the process stabilizes, they switch to less aggressive cytostatics.

The use of methods of extracorporeal hemocorrection (blood purification by plasmapheresis with ultraviolet irradiation blood) improves microcirculation and accelerates the treatment of diseases.

To improve the rheological properties of blood, antithrombotic drugs are used: trental, chimes. A good effect as concomitant therapy is given by vasodilators: nicotinic acid, complamin.

The choice of the dosage of the drug, the duration of therapy, the combination of drugs to obtain the optimal therapeutic effect with a minimum of side effects is a difficult medical task, only professionals can do it. Without proper treatment, the prognosis of the disease is poor. The five-year survival rate of patients is only 10%. Only adequate pathogenetic therapy with the above drugs can prolong life and improve its quality. This group of diseases is not treatable with folk remedies and herbal preparations. Do not self-medicate!

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Inflammation of the walls of blood vessels - vasculitis

Vasculitis is a term that refers to a group of diseases in which there is inflammation of the walls of blood vessels with their subsequent destruction.

In most cases, vasculitis affects several organs at once, as a result of this disease, blood supply and tissue nutrition are disturbed.

Forms of the disease

Physicians distinguish primary and secondary vasculitis. In the first case, vasculitis develops as independent disease, which is not accompanied by other ailments.

Secondary vasculitis is a consequence of some other pathology. Often the cause of secondary vasculitis is an infection (sepsis, scarlet fever, meningitis, etc.) or a skin disease (most often, psoriasis). Less commonly, secondary vasculitis develops against the background of the formation of a malignant tumor. This form of the disease, as a rule, passes after the cure of the disease that provoked inflammation of the vessels.

There are several classification systems for vasculitis, depending on the location, severity of the course and the causes of development. Some types of vasculitis affect only the skin, without causing much harm to the internal organ. Other varieties of the disease affect the vessels of vital organs and pose a threat to the life of the sick person.

Reasons for the development of the disease

Since quite heterogeneous diseases are included in the group of primary vasculitis, it is extremely difficult to identify the causes of this pathology. In most cases, it is not possible to identify the cause of vasculitis.

To date, the dominant theory about the origin of vasculitis is the recognition of the infectious nature of the disease. A number of forms of vasculitis have a clearly defined temporal relationship with various diseases caused by infectious agents. Moreover, the presence of a focus of chronic infection in the body is possible reason the development of a relapse of the disease or the occurrence of secondary complications of vasculitis.

In some cases, the cause of the development of inflammation of the vessels is an allergic reaction of the body to the reception. various medicines. Today, about 150 different drugs have been identified, the use of which can provoke the appearance of vasculitis. Most often, a similar reaction is given by taking antibiotics, sulfonamides, B vitamins, iodine preparations, analgesics, radiopaque substances, tuberculostatics.

It is impossible to exclude a hereditary predisposition to the development of vasculitis, since this disease is often observed in blood relatives.

Clinical picture

Vasculitis is a disease characterized by clinical polymorphism, that is, the symptoms and manifestations of the disease can vary significantly. Symptomatic picture may vary depending on the localization of the affected area and the presence of concomitant diseases.

Complaints of patients with vasculitis are diverse. As a rule, the disease begins acutely with the appearance of signs of the development of the inflammatory process.

Among common symptoms vasculitis is worth highlighting:

Decreased patient weight.
Constant subfebrile temperature.
Rapid fatigue.
Headache.

Other symptoms of vasculitis depend on which specific organs are affected.

With inflammation of the vessels of the skin, a characteristic rash appears, outwardly similar to small hemorrhages. As the disease progresses, the inflammatory process may be involved muscle tissues, nerves, joints.

If vasculitis affects the vessels of the kidneys, then patients develop nephritis, renal infarction, or other similar pathologies.

In the event that the main organ of the lesion is the joints, pain is noted, signs of arthritis appear, which proceeds with damage, but without deformities of the joints.

With the defeat of the vasculitis of the nervous system, patients have a violation of sensitivity. Some patients develop hypersensitivity, while others - its complete absence.

Vasculitis can also affect the coronary vessels, and this is the most dangerous form of the disease, as a result of which heart attacks and strokes develop.

In any case, vasculitis is a disease characterized by a long course, frequent relapses and labor-intensive treatment.

Diagnostic methods

The basis for the success of vasculitis treatment is early diagnosis. The later in the course of the disease a correct diagnosis is made, the more likely development complications and irreversible changes.

Diagnosis is based on the study of the clinical manifestations of the disease, that is, the patient's complaints and data obtained as a result of an objective examination and examination.

important diagnostic factor is the sex and age of the patient. So, hemorrhagic vasculitis, mainly occurs in children or young people. Such a form of vasculitis as nonspecific aortoarteritis affects mainly girls under 30 years old, and Buerger's obliterating thromboangiitis affects mainly men.

Treatment and symptoms of vasculitis

Vasculitis, also called angiitis, literally means "inflammation of blood vessels". This is a group of systemic diseases, the common manifestation of which is damage to the vascular wall. In this case, the targets are the vessels various sizes: from small capillaries to the largest vessel, the aorta.

Types of vasculitis

All vasculitis are divided into two large groups. This division was based on the reasons that caused the development of this pathology.

1. Primary vasculitis. They belong to independent systemic diseases, since inflammation is based on an autoimmune process. Most of them are hereditary.

2. Secondary vasculitis - occur against the background of other diseases of the body, as a rule, infectious origin(meningitis, typhus).

In 2012 clinical classification vasculitis has been revised. It was based on several features: the caliber of the affected vessels and the localization of the process in the body.

1. Depending on the caliber of the affected vessels, vasculitis is divided:

- with damage to large vessels - giant cell arteritis and nonspecific aorto-arteritis;

- with lesions of medium-sized vessels - Kawasaki disease and polyarteritis nodosa;

- with damage to small vessels, it is divided, depending on the pathogenesis, into:

Autoimmune vasculitis - ANCA-associated vasculitis (ANCA - antineutrophil cytoplasmic antibodies);

immunocomplex vasculitis.

- with lesions of vessels of various calibers - Cogan's syndrome and Behcet's disease.

2. Depending on the damage to target organs:

- with damage to one organ - skin vasculitis, vasculitis of the central nervous system;

- vasculitis, combined with systemic diseases - with rheumatism, systemic lupus erythematosus, etc.;

- vasculitis, combined with certain diseases with an established etiology - with syphilis, hepatitis, oncological diseases, other.

Reasons for the development of vasculitis

The development of vasculitis, both primary and secondary, is based on a violation of the immune system, which leads to the development of an autoimmune or immunocomplex mechanism of inflammation. Autoimmune damage is a distortion of the immune system. In this case, the body begins to produce antibodies to its own cells, in this case- to the cells of the vascular wall (endothelium). In the immunocomplex mechanism of inflammation, vascular cells are affected by complexes circulating in the blood, consisting of an antigen-antibody association. For some reason, they are not neutralized by the body.

The factors that trigger the development of vasculitis are varied:

- stress;

- viral or bacterial infection;

- chronic inflammatory diseases;

- chronic systemic processes;

- hormonal disorders;

- immunodeficiency states;

- action toxic substances(including nicotine, drugs and alcohol), etc.

It should be borne in mind that this disease is hereditary. That is, the tendency to develop it is transmitted from parents to children, which requires non-specific prophylaxis in risk groups.

Symptoms of vasculitis

The clinical picture of the disease depends on the size of the affected vessels, and on the localization of the process. Common points for all types of vasculitis are the following:

- the development of the disease proceeds in stages;

- there is a systemic damage to the body;

- the presence of clinically and laboratory confirmed inflammatory manifestations.

The onset of the disease is acute or subacute. Generalized inflammation manifests itself in the form of an increase in body temperature, a decrease in appetite, asthenic syndrome(weakness, fatigue, malaise), hepato-lienal syndrome (enlarged liver and spleen), polylymphadenopathy (enlarged lymph nodes different localization). In some cases, there may be: nausea, vomiting, abdominal pain, chest pain, palpitations, arrhythmias, pain in small and large joints.

With the defeat of the gastrointestinal tract observed: nausea, vomiting, abdominal pain. Damage to the lung tissue is manifested by shortness of breath, coughing. When the nervous system is damaged, there are severe manifestations in the form of symptoms of irritation meninges, the development of ischemic strokes and hemorrhages in the brain tissue. Heart disease manifests as endocarditis, myocarditis, or pericarditis. Skin lesions appear as papular, erythmatous, or hemorrhagic rashes.

In some cases, necrosis of the rash may be observed.

Features of eosinophilic vasculitis

Eosinophilic granulomatous vasculitis, or Churg-Strauss syndrome, is a systemic, autoimmune lesion small vessels (arterioles and venules). With this disease, a characteristic eosinophilic infiltration of the perivascular space is observed, followed by the formation of granulomas in various organs and tissues. This type of vasculitis is often associated with drug allergies and bronchial asthma. Its prevalence in the population is quite low. Pathology occurs with a frequency of approximately 1: 1 million cases per year.

The onset of the disease is acute. Symptoms of intoxication are pronounced, symptoms from various organs can be observed:

- symptoms from the gastrointestinal tract in the form of abdominal pain;

- symptoms from the respiratory system - shortness of breath, changes in radiographs;

- on the part of the skin - erythematous and hemorrhagic rashes;

- circulatory systems - pain in the heart, shortness of breath, pericarditis, heart attack;

- from the joints - pain and stiffness in the joints and muscles.

The diagnosis is confirmed by the presence of antibodies to the cytoplasm of neutrophils (ANCA) in the blood test, the presence of eosinophilia in the blood test and the identification of characteristic granulomas during the examination.

Complications of vasculitis

Complications of vasculitis are associated with damage to various organs, and in some cases are quite severe.

With the defeat of the circulatory system, heart attacks, endocarditis and pericarditis can be observed.

With the defeat of the nervous system - psychosis, strokes.

From the side respiratory system This is pneumonitis with the development of respiratory failure.

From the urinary system observed nephritis, proteinuria. From the gastrointestinal tract - vomiting, bleeding, perforation of the intestinal wall, exudative inflammation peritoneum.

The manifestations of vasculitis are very non-specific, so making the correct diagnosis in some cases is difficult.

Although the presence of skin symptoms greatly facilitates the task. Diagnosis requires comprehensive examination patient, which includes:

- blood and urine tests;

- determination of indicators of systemic inflammation;

- determination of indicators of the function of individual organs;

— endoscopic examination GIT:

- radiography of the lungs:

— researches of function of kidneys and other.

There are a number of diseases similar to vasculitis:

- infectious diseases - measles. rubella. chicken pox, parotitis. With these diseases, there is also an acute onset, high fever and the presence of rashes on the skin. It is possible to distinguish these diseases from vasculitis on the basis of the excellent nature of the rash and the course of the disease;

- systemic autoimmune processes - rheumatoid arthritis, systemic lupus erythematosus, scleroderma. dermatomyositis. These diseases, like vasculitis, begin acutely or subacutely, with fever and symptoms of intoxication. There may also be pain in the joints, signs of damage to the lung tissue, kidneys and gastrointestinal tract. They differ in characteristic clinical manifestations and changes in blood tests. However, the clinical picture of systemic diseases is characterized by the development of secondary vasculitis, which must be distinguished from primary ones;

- damage to the arteries: endarteritis, atherosclerosis. In these diseases, the vascular wall is also affected - the endothelium due to the deposition of lipids on it or the formation of inflammation of the vascular endothelium. The diagnosis can be made on the basis of a comprehensive examination of the patient;

- allergic dermatitis, eczema, urticaria. For these diseases, as well as for vasculitis, the presence of rashes is characteristic, and sometimes there is an increase in temperature;

- diseases of the gastrointestinal tract (esophagitis, gastritis, colitis, peptic ulcer stomach and duodenum), respiratory (bronchitis, pneumonia) and urinary system (nephritis). Vasculitis can resemble these diseases in its own way, since vascular damage occurs throughout the body, including the vessels of the mucous membranes of the stomach, intestines, lungs and renal glomeruli of the membranes. Correct Diagnosis help to conduct additional research.

Medical treatment of vasculitis

First of all, the treatment of vasculitis should be comprehensive, and include the elimination concomitant disease, which became the background for the development of vasculitis. There are several directions in the treatment of vasculitis.

They are aimed at:

- suppression of the distorted function of the immune system - the use of systemic glucocorticosteroids (prednisolone, dexamethasone, diprospan), cytostatic drugs (methotrexate, azathioprine) and immunosuppressants (cyclosporine);

- relief of systemic inflammation - glucocorticoids and non-steroidal anti-inflammatory drugs (aspirin, ibuprofen);

- prevention of bleeding - the use of platelet mass, heparin and its derivatives (fraxiparin, fragmin, clexane);

- desensitization - plasmapheresis, the use of low doses of allergens;

- restoration of vascular tone - solcoseryl, dicynone, calcium gluconate, aminocaproic acid, detralex, venoruton, aescusan, vitamins (B12, E, C) and others

- treatment of symptoms associated with impaired activity of organs and systems - depends on the localization of the process,

- in some cases, antibiotics are required (more often with secondary vasculitis),

- for rashes, the use of gels, ointments and creams is effective - solcoseryl, troxevasin, venoton, acemin and heparin ointment.

Traditional medicine for vasculitis

Phytotherapy methods are effective for the treatment of vasculitis.

For this, various infusions and collections based on sophora, yarrow, elderberry and nettle or on the basis of poplar, elderberry, succession, horsetail, mint leaves are used.

Japanese Sophora will work more effectively if you use its alcohol tincture. The fruits of the plant (20 g) are used, which are poured with 100 ml of vodka and infused in a dark place for 7-10 days. Then the tincture is filtered and taken 20-30 drops 2-3 times a day.

Alcoholic infusion of mountain arnica flowers is a good healing agent. To prepare it, you need 1 part of raw materials and 20 parts of vodka or 70% alcohol. Take orally 20-40 drops, 2-3 times a day.

If you are intolerant to alcohol, you can prepare an aqueous infusion by pouring 1 teaspoon of herbs into 1 cup of boiling water, and insisting for 1 hour. The infusion is then filtered and taken 1 tablespoon 3-4 times a day.

The action of odorous rue in vasculitis is based on the content of a large amount of rutin in it, which well enlarges the vessels. For treatment, an infusion is used, consisting of 1 tsp. rue leaves and 2 cups boiled water. The mixture is infused for 8 hours and taken strictly 1/3 cup 3 times a day. it potent agent, the use of large doses of which can cause complications.

Collection based on nettle leaves (20 g), thick-fruited sophora fruits (20 g), bird's grass knotweed (20 g), yarrow (15 g), elderberry fruits (5 g), has anti-allergic properties. An infusion is prepared from the mixture (1 tsp per 1 glass of water), and is taken orally 100 ml 2 times a day

Apply and various tinctures based on immunomodulatory plants (ginseng, eleutherococcus).

It is effective to use an infusion of licorice root, which has an effect similar to corticosteroids.

Hirudotherapy is also used for vasculitis (treatment with leeches). This is an effective means of stimulating hematopoiesis. Procedures are carried out 1-2 times a week, lasting 30-60 minutes. The duration of treatment is about 10 days, and depends on the patient's condition.

Vasculitis is dangerous for its complications, so you should not use only methods for treatment. traditional medicine the solution to the problem must be complex.

Disease prevention

There is no specific prevention (vaccine) for this disease.

The main methods of nonspecific prevention of vasculitis are as follows:

— timely detection and complex treatment of systemic autoimmune diseases,

– timely detection and treatment of acute and chronic infectious diseases,

- strengthening immunity with the help of immunomodulators,

- hardening of the body,

Disclaimer: This article is for informational purposes only, for diagnosis and treatment you need to contact your doctor! The application of the recommendations prescribed above should be agreed with your doctor.

Hemorrhagic vasculitis is also called allergic purpura, capillary toxicosis, or, by the name of the authors who described it, Henoch-Schonlein disease. The disease is included in an extensive group of vasculitis, inflammation of blood vessels of various types and sizes.

The peculiarity of the reaction of the vascular wall is aseptic conditions (the absence of a pathogen) and the dominant role of a pronounced allergic reaction. The disease is accompanied by increased thrombus formation, impaired blood microcirculation in tissues and internal organs, which leads to damage to the kidneys, joints, and digestive organs.

Men under the age of 20, children from 7 to 13 years are more susceptible to capillary toxicosis. The incidence in these populations ranges from 14 to 24 per 10,000.

What it is?

Hemorrhagic vasculitis is a rheumatic systemic disease characterized by chronic inflammation of the capillaries, arterioles and venules that feed the skin, joints, organs. abdominal cavity and kidneys. Another name for hemorrhagic vasculitis is Henoch-Schonlein disease.

Causes

The causes of the disease have not been precisely established. It is considered to be autoimmune. However, a relationship with activation factors was found. pathological processes. These include:

traumatic damage to the skin and blood vessels;
transferred viral and bacterial infectious diseases, special importance is attached to sharp and chronic inflammation in the upper respiratory tract(influenza, SARS, tonsillitis, sinusitis), measles, frequent tonsillitis, chicken pox, typhus, streptococcal diseases;
vaccinations during routine vaccination, prophylactic use of immunoglobulins;
food allergies;
restructuring of the body in malignant and benign tumors;
changes in women during pregnancy;
the influence of increased doses of solar radiation (with prolonged sunburn), temperature fluctuations, radiation;
allergic reactions to drugs (usually antibiotics, sedatives and antihypertensives);
metabolic disorders in endocrine diseases(diabetes);
family genetic predisposition.
domestic and professional poisoning, toxic infection;
in children - helminthic invasions;
response to insect bites.

Hemorrhagic vasculitis in adults develops more often in old age, with weak and impaired immunity.

Symptoms of hemorrhagic vasculitis, photo

The manifestations of the disease depend on which organs and systems are covered by it. Hemorrhagic vasculitis can manifest itself in one or more groups of symptoms (see photo). The main ones are:

skin lesions;
joint damage;
lesions of the gastrointestinal tract;
renal syndrome;
in isolated cases - damage to the lungs and nervous system.

The most characteristic is the acute onset of the disease, accompanied by an increase in temperature to febrile numbers. There are cases when there is no increase in temperature.

Skin syndrome (or purpura) occurs in every patient. It manifests itself in the form of a symmetrical small-spotted or maculopapular hemorrhagic rash, localized mainly on the extensor surfaces of the lower (rarely upper) limbs, around large joints and on the buttocks. The rash can be represented by single elements, or it can be intense, combined with angioedema. As a rule, rashes are recurrent undulating. When the rash fades, pigmentation remains. In the case of frequent relapses, peeling of the skin occurs at the site of the rash.
Articular syndrome is often observed simultaneously with skin syndrome, it is most typical for adults. Most often, the large joints of the legs are covered by the process, most rarely - the elbow and wrist joints. Pain, redness and swelling are noted. Typical for hemorrhagic vasculitis is the volatile nature of articular lesions. In 25% of cases, migratory joint pain precedes skin lesions. Articular syndrome, which rarely lasts more than a week, is sometimes combined with myalgia and swelling of the lower extremities.
In 2/3 patients, abdominal syndrome is also observed. It is characterized by spastic abdominal pain, nausea, vomiting, stomach bleeding. At the same time, really life-threatening phenomena are observed only in 5% of patients.
Renal syndrome is less common (40 to 60% of cases) and does not develop immediately. Manifested in the form of hematuria (excretion of blood in the urine) varying degrees severity, in rare cases, it is possible to develop glomerulonephritis (inflammation of the kidneys) of a hematuric or nephrotic form. More often, glomerulonephritis manifests itself in the first year of the disease, less often it happens during the next relapse of hemorrhagic vasculitis or after the disappearance of all other manifestations of the disease.

In isolated cases, pulmonary complaints are observed - bleeding, hemorrhage. Also, lesions of the nervous system rarely occur - headaches, convulsions, encephalopathy or polyneuropathy may develop.

Hemorrhagic vasculitis in children

Symptoms of vasculitis in children, depending on the frequency of their occurrence, are distributed as follows:

rash in the form of papules and red spots - 100% of cases
arthritis and joint pain - 82%
abdominal pain - 63%
kidney damage (glomerulonephritis) - 5-15%.

Most often, recovery occurs spontaneously. Therefore, the disease is relatively benign in childhood, especially if the rules of nutrition are followed and the elimination of a possible causative factor. After the inflammation subsides, the risk of recurrence is maximum in the first 3 months, but may be later.

After recovery, you should adhere to the principles of dietary nutrition throughout the year and avoid contact with allergens that enter through the respiratory tract.

Skin syndrome in the clinical picture of vasculitis is the leading one. It is characterized by the following features:

the appearance of a rash called purpura;
its symmetry;
purpura rises above the skin and is well palpable;
at the same time, there may be red spots, pimples, vesicles, which are characterized by itching;
primary rashes on the feet, later they spread to the thighs and buttocks;
after a couple of days, the rashes turn from bright red to brown, and then turn pale and disappear;
sometimes there may be pigmented foci that persist for a long time.

The development of glomerulonephritis usually occurs a month after the onset of the first symptoms of the disease. Kidney damage can occur with minimal manifestations or be prone to an aggressive course. Depending on this, the clinical and laboratory signs of glomerulonephritis are very diverse. They include:

protein in the urine;
edema, sometimes very pronounced as part of the nephrotic syndrome, in which the loss of protein in the urine can reach 3.5 g per day;
pain in the lumbar region;
redness of urine (gross hematuria) or only microscopically determined presence of red blood cells in it (microhematuria);
transient increase in pressure.

Abdominal syndrome is a consequence of intestinal ischemia. In children, it is characterized by:

nausea;
vomit;
the appearance of bloody streaks in the stool;
diffuse pain all over the abdomen like colic;
pain worsens after eating;
loose stool.

The abdominal form of hemorrhagic vasculitis resembles " acute abdomen”, traditionally requiring surgical intervention. However, with this disease, it is contraindicated, because. due to vascular damage. Appropriate drug therapy is required.

The articular syndrome in hemorrhagic vasculitis has typical features that distinguish it from the articular syndrome in other diseases (osteoarthritis, rheumatoid arthritis, gout). These include:

no destruction of the joint;
symmetry of the lesion;
lack of pain migration;
frequent damage to the ankle and knee joints.

Treatment of a child with hemorrhagic vasculitis must begin in a hospital setting. A three-week bed rest is usually suggested, followed by an extension.

See photo

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How is hemorrhagic vasculitis diagnosed?

Henoch-Schonlein disease is easy enough to expose to a patient who has all three main symptoms.

There are slight differences in the course of the disease in children and adults.

More than 30% of children develop a fever.
Characterized by an acute onset and course of the disease.
Abdominal syndrome is accompanied by loose stools with streaks of blood.
Often, the kidneys are involved in the process from the very beginning, with the detection of hematuria and proteinuria in urine tests.

In adults:

The onset of the disease is blurred, the symptoms are milder.
Abdominal syndrome occurs in only 50% of patients and is rarely accompanied by nausea and vomiting.
Kidney damage leads to chronic diffuse glomerulonephritis, with the formation of chronic renal failure.

Diagnostics

Diagnosis of the disease is carried out in a complex manner. First of all, the doctor conducts an oral survey, during which he finds out the patient's complaints, collects an anamnesis. In the future, the following studies may be assigned:

Ultrasound of the abdominal organs and kidneys.
Determining the duration of bleeding.
Carrying out a cuff test, as well as a tourniquet and pinch test.
Examination of faeces.
Conducting immunological studies, as well as blood biochemistry.
Virological studies to detect hepatitis.
Holding endoscopic examination gastrointestinal tract.
A blood test reveals an increased number of leukocytes and ESR. Immunological disorders are also observed in the form of an increase in immunoglobulins A and a decrease in the level of immunoglobulins G.
During the physical examination, the doctor checks the functioning of the joints, carefully examines skin in order to detect changes in their color and possible rashes. In the event that swelling is found in the face, this may indicate a violation of the normal functioning of the urinary system. You should also check your pulse.

The disease should be distinguished from the following ailments and conditions:

Infective endocarditis.
Systemic vasculitis (Goodpasture's syndrome, periarteritis nodosa, Behcet's disease).
Diffuse connective tissue diseases (systemic lupus erythematosus).
Meningococcemia.
Macroglobulinemic purpura of Waldenström.
Yersiniosis.
Crohn's disease.

Additionally, a trepanobiopsy procedure and a bone marrow examination may be prescribed.

See photo

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Treatment of hemorrhagic vasculitis

First, you need a diet (excluded allergenic products). Secondly, strict bed rest. Thirdly, drug therapy (antiplatelet agents, anticoagulants, corticosteroids, immunosuppressants-azathioprine, as well as antithrombotic therapy).

The following drugs are used:

fibrinolysis activators - nicotinic acid.
heparin at a dosage of 200-700 units per kilogram of body weight per day subcutaneously or intravenously 4 times a day, gradually canceled with a decrease in a single dose.
antiplatelet agents - chimes at 2-4 milligrams / kilogram per day, trental intravenously by drip.
In severe cases, plasmapheresis or glucocorticosteroid therapy is prescribed.
In exceptional cases, cytostatics such as Azathioprine or Cyclophosphamide are used.

In general, the course of the disease is favorable, and immunosuppressant or cytostatic therapy is rarely used (for example, with the development of autoimmune nephritis).

The duration of treatment for hemorrhagic vasculitis depends on clinical form and severity: 2-3 months - with a mild course; 4-6 months - with moderate; up to 12 months - with severe recurrent course and Shenlein-Genoch nephritis; at chronic course carry out treatment by repeated courses within 3-6 months.

Children must be in the dispensary. Conducted over 2 years. The first 6 months the patient visits the doctor monthly, then - 1 time in 3 months, then - 1 time in 6 months. Prevention is carried out with the help of rehabilitation of foci of chronic infection. Examine feces regularly for helminth eggs. Such children are contraindicated in sports, various physiotherapy and exposure to the sun.

Answers on questions

What is meant by a hypoallergenic diet?

First of all, highly allergenic foods such as eggs, chocolate, citrus fruits, coffee and cocoa, sea fish and seafood, nuts should be excluded from consumption. It is also necessary to give up fatty and fried foods. The diet should be dominated by low-fat dairy products, stews and boiled dishes. Green apples, cereals, turkey and rabbit meat, vegetable oils are allowed.

What is the prognosis for hemorrhagic vasculitis?

As a rule, the prognosis, especially when mild form illness, auspicious. The severe course of hemorrhagic vasculitis is fraught with recurrence of the disease and the occurrence of complications (nephritis complicated by renal failure). With a lightning-fast form, there is a high probability of death within a few days after the onset of the disease.

Are patients who have undergone hemorrhagic vasculitis, for dispensary registration?

Dispensary registration in adults after past illness not shown. Children should be observed for two years. Monthly for the first six months, quarterly for the next six months, and every six months for the last year. Children should not go in for sports, physiotherapy and insolation (stay in the sun) are contraindicated for them.

Is it possible to develop complications and consequences after hemorrhagic vasculitis and which ones?

Yes, the disease can cause intestinal obstruction and peritonitis, chronic renal failure, dysfunction of internal organs (heart, liver), anemia and pulmonary bleeding, children may develop hemorrhagic diathesis.

How to prevent exacerbations?

The patient after discharge from the hospital should not forget about his illness at home. Of course, by that time he will already know everything about the nature of the disease, the prevention of exacerbations, behavior in everyday life, nutrition and daily routine. Having plunged into the home atmosphere, the patient will not take any medications without a doctor's prescription, will not pounce on products that can provoke a relapse (allergens), but at the same time he will eat fully and will take calm easy walks in the fresh air every evening.

In addition, a person is contraindicated:

Excessive excitement, mental stress;
Vaccinations (possible only for health reasons);
Heavy physical work(children are exempted from physical education lessons);
hypothermia;
The introduction of immunoglobulins (anti-staphylococcal, anti-tetanus, etc.).

Due to the fact that hemorrhagic vasculitis is predominantly a childhood disease, special recommendations are provided for babies (or parents?):

Every six months, the child visits the attending physician (in the absence of exacerbations);
Dispensary observation for at least 5 years if the kidneys remain healthy, but if they are damaged, control may be lifelong;
Children are completely exempt from physical education for a year, then they move to the preparatory group;
3 times a year, a mandatory visit to the dentist and otolaryngologist is required;
Regular urinalysis (general and according to Nechiporenko) and fecal analysis for helminths;
Vaccinations are excluded for 2 years, and after this time, routine vaccination is carried out, but with the permission of the attending physician and under the "antihistamine cover";
Compliance with an anti-allergenic diet - 2 years;

Advice to parents or other relatives about home treatment, relapse prevention, nutrition, and behavior at school and at home.