Vaskulit, symptoms and treatment vaskulita
Vaskulit - an inflammation of walls blood sosudov.
Primary vaskulit Pervichnye vaskulity are the independent illnesses concerning first of all to the competence of rheumatologists though diagnostics and treatment of these diseases are impossible without participation of doctors of other specialities: otolaryngologists, oculists, neuropathologists, dermatologov, etc. the Inflammation of a wall of blood vessels - the integral line of these diseases which is found out in all without an exception of the diseased. Number primary system vaskulitov concern: nonspecific aortoarteriit (synonyms: «illness Takajasu","a syndrome of an arch of an aorta»); gigantokletochnyj arteriit (synonyms: « Temporal arteriit "," senile arteriit "," illness Hortona »); nodular poliarteriit; illness of Kawasaki; granulematoz Vegenera; microscopic poliangiit; eozinofilnyj angiit and granulematoz (a synonym:« syndrome Charga-Shtrauss »); krioglobulinemichesky vaskulit; purple Shenlejna-Genoha (a synonym:« gemorragichesky vaskulit »). At all listed diseases there is an inflammation in a wall of vessels, however the calibre of the amazed blood vessels at different forms vaskulitov neodinakov and varies from large arteries (diameter 1,0 sm and more) to the smallest arteriol, capillaries and venul, visible only under a microscope. neodinakov and inflammation type. All it explains extremely expressed variety of clinical displays primary system vaskulitov and their dissimilarity the friend on druga.
Secondary vaskulit Vtorichnyj vaskulit develops as an element of other disease and can be considered or as facultative, unessential, its display, or as complication. As an example many infectious diseases can serve: the scarlet fever, sypnoj a typhus, a meningitis, a sepsis, - and also skin diseases, such as psoriaz, etc. vaskulit can Sometimes be one of displays of a malignant tumour of this or that body; In this case vaskulit also will be secondary as after successful surgical, beam or chemotherapeutic treatment of a tumour accompanying it vaskulit, as a rule, disappears without everyone special lechenija.
Kak it is visible, the word "vaskulit" unessentially is present at the name of these illnesses to what sometimes happen some misunderstanding are connected: sometimes patients whom as a result of difficult special inspection was, for example, the diagnosis «granulematoz Vegenera» is made, can incorrectly believe, that come out at early stages of inspection the assumption about system vaskulite was «a medical error».
V same time should be ascertained, unfortunately, that diagnostic errors in situations when it is a question about system vaskulitah, are not a rarity; apparently, many from reading now have felt these lines it on themselves or the relatives. The reasons for such errors a little. First, primary system vaskulity - rare diseases (though last years the tendency to their increase all over the world was outlined), and the doctors working in usual medical institutions (instead of in the specialised centres), simply cannot save up necessary experience in recognition and treatment of these illnesses. Secondly, for a long time the clinical picture of the majority primary system vaskulitov happens not specific and the general weakness, loss of appetite and weight of a body, skin vysypanija, pains in joints, etc., - inherent, except vaskulitov, still many other things to diseases switches on only such widespread signs, as a fever. Thirdly, situations when system vaskulit reminds on the current infectious disease, a tumour, or other disease are possible. So, for example, granulematoz Vegenera with defeat of fabrics of an orbit of an eye almost everywhere at the first stages of inspection interpret as a malignant tumour of an eye-socket; the same granulematoz Vegenera with primary defeat of bosoms of a nose or an average ear reminds a usual antritis and an average otitis; granulematoz Vegenera with primary defeat of lungs simulates a tuberculosis of lungs (or a cancer of lungs). Eozinofilnyj angiit and granulematoz (syndrome Charga-Shtrauss) it is frequent within the several first months or even years is shown only by the attacks of an asthma indistinguishable from attacks, typical for a bronchial asthma. Gigantokletochnyj (temporal) arteriit - the disease developing at persons is more senior 50 years and shown usually a headache in the field of a temple, a cinciput or a nape, and also sight infringement, - as «an atherosclerosis of vessels of a brain», "migraine", «nevrit a trigeminal nerve», "glaucoma", etc. more often is wrongly treated. Such diagnostic errors are typical for all rare diseases: seldom meeting illness originally accept for the atypical form more widespread zabolevanija.
Odnako meet an error and other sort, connected with superfluous diagnostics primary vaskulitov. Among the clinical physicians few familiar in practice with vaskulitami, exists the tendency to name «system vaskulitom» (especially often «nodular poliarteriitom» and «gemorragicheskim vaskulitom») any not clear status when at the patient it is long is saved a fever and there is still this or that set of nonspecific signs. Very often in such situations the diagnosis as if "proves" biopsija skin - research issechyonnogo a site of a skin and hypodermic kletchatki under a microscope, a finding out inflammation of vessels. It is necessary to notice, however, that this method of research does not allow to distinguish authentically primary system vaskulit and secondary (symptomatic) vaskulit. So, skin vysypanija in the form of small hemorrhages with a histologic picture vaskulita vessels mikrotsirkuljatornogo skin channels can be the display, at least four primary system vaskulitov: purples Shenlejna-Genoha, krioglobulinemicheskogo vaskulita, eozinofilnogo angiita and granulematoza Charga-Shtrauss, granulematoza Vegenera, - and also a numerous number of other illnesses, for example, infectious endokardita, illnesses the Crone, nonspecific ulcer kolita, a virus hepatitis In, iersinioza and a pseudo-tuberculosis, limfomy, tumours of various localisation, etc. the Diagnosis in such cases is established not by means of any one research (biopsija skin, etc.) And on the basis of all complex of clinical signs, features of development of the illness, the given many laboratory and tool researches; thus the inspection volume (the list of necessary diagnostic methods) always is defined individually for everyone patsienta.
Vsyo the stated has the purpose to underline the big complexity of a problem. Diagnostics (and the more so treatment) system vaskulitov in most cases trudnoosushchestvimy in unspecialized medical institutions. And are absolutely inadmissible also nothing attempts of patients independently are justified to diagnose for themselves vaskulit and to spend samolechenie.
Slozhen a question and on the reasons of development primary system vaskulitov. In the general view the occurrence mechanism vaskulitov explain immune dysfunction when cages of immune system of an organism and aggressive substances developed by them start to attack own fabrics and bodies. In turn, different factors can call such dysfunction. Infections - both sharp, and chronic have great value, - as last years is shown, that some infectious agents are capable to "deceive" immune system, to pervert the immune answer, perenatselivaja it from microbic bodies on internal structures of an organism. At least, at two system vaskulitah, carried to "primary", - nodular poliarteriite and krioglobulinemicheskom vaskulite - the role of viruses is proved: accordingly, a hepatitis virus In and a virus of a hepatitis v the centres of a chronic bacterial (purulent) infection, especially chronic tonsillitis (retsidivirujushchie quinsy). To other risk factors, potentially capable to call develop ment vaskulita, carry abusing medicines, uncontrolled introduction of vaccines and whey, excessive uvle chenie "sunburn" and stay on the sun, long overcooling. Sometimes the role of "a trigger hook» is carried out by a physical trauma, a psychoemotional overstrain or the alcohol use (sometimes even small doses of alcohol unexpectedly appear are capable to provoke illness development). Certainly, the human body in normal conditions without effort resists to all named kinds of influences; therefore assume, that vaskulity develop only as a result of simultaneous sochetannogo influences of several factors when possibilities of adaptation of protective systems appear exceeded. The inconsistency of systems of protection can be connected with features of the internal hormonal status also: Some vaskulity (for example, nonspecific aortoarteriit Takajasu and gigantokletochnyj arteriit) develop at women that explain contributing action of high concentration in blood of an estrogen - female sexual hormones, - calling disbalans as immune system is more often; at the same time others vaskulity (for example, nodular poliarteriit), on the contrary, amaze men is more often. The scientific explanation of all these processes suffers still numerous blanks and the logic discrepancies, much remains not clear and demands additional studying. The role of hereditary (genetic) predisposition to development system vaskulitov is not up to the end clear, for example: in several cases occurrence vaskulitov at members of one family is noted; some genes which with bolshej frequency meet among the diseased system vaskulitami, than among other persons are identified. It is shown, that in case of need changes of a kidney to the patient system vaskulitom, called heavy defeat of kidneys, use of the donor body received from near relations as the genetic relationship increases risk of relapse vaskulita in the replaced kidney is undesirable. Nevertheless, in overwhelming majority of cases vaskulity are not descended from parents to children, and the risk of development of these illnesses at posterity minimalen.
Sovremennaja a biomedical science continues to develop promptly, therefore it is possible to hope, that not clear questions will receive the permission in the future, including in close budushchem.