Vasculitis
Vasculitis means inflammation of blood vessels. There are a number of different disorders where there is autoimmune induced inflammation of different vessels, though autoantibodies are not always detectable. Different disorders tend to affect different age groups: giant cell arteritis is predominantly a disease of older people, causing inflammation and pain and tenderness of the arteries of the scalp, often in association with polymyalgia rheumatica, where there is pain and stiffness affecting the muscles of the neck and shoulders and lower back. This disorder needs treatment with steroids to prevent the possibility of loss of vision as a result of inflammation affecting the blood vessels that supply the eye.
Henoch-Schonlein Purpura Usually affects younger people and is caused by an antibody attack on small blood vessels, usually those in the skin and in the kidney, with associated pain in joints, and sometimes gut involvement producing bloody diarrhoea. Mild disease requires only symptomatic treatment; kidney involvement may require immunosuppression.
Kawasaki's disease Affects children and can cause the development of swellings, or aneurysms, on the coronary arteries as well as affecting the skin of the hands and lips. It is thought that this is possibly due to activation of the immune system by a toxin secreted by a bacterium called staphylococcus aureus. Treatment with immunoglobulins given intravenously may prevent the formation of aneurysms, though the mechanism is ill understood.
Polyarteritis Nodosa Is an inflammatory condition of small and medium sized arteries, usually affecting the lung and kidney, together with muscles and nerves. It may be associated with hepatitis B virus infection, when treatment with the agent interferon alpha might be indicated. In patients and who have not been exposed to hepatitis B immunosuppression may help.
Wegener’s granulomatosis Is a condition which usually affects small blood vessels in the lungs, the kidneys, and the skin. There may be associated collections of inflammatory cells forming swellings called granulomas. This is due to the action of an autoantibody called ANCA (anti neutrophil cytoplasmic autoantibody), though why this should occur is uncertain. This condition, together with a similar disease called microscopic polyangiitis, requires vigorous treatment in specialist centres.
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