One of the most common and dangerous vascular diseases is Horton's disease. Why it is dangerous and how it is treated will be described here.
Nature of disease
Horton's disease is also known by names such as giant cell temporal arteritis or vasculitis. This disease belongs to the category of autoimmune and is inflammatory in nature. Like other systemic vasculitis, it usually affects veins, arteries, and other large blood vessels. Very often, this disease is localized within the sheath of the carotid artery.
This syndrome is named after Doctor Horton. The disease was discovered in America, in the thirties of the twentieth century. Statistics show that temporal arteritis is most common in northern Europe and the Scandinavian countries. As a rule, the disease affects people of retirement age, and women get sick almost twice as much as men.
Background
It is believed that Horton's disease occurs due to a drop in the level of human immunity. Numerous blood tests show that antibodies accumulate at the site of arterial lesion with vasculitis. Moreover, the development of this disease may depend onthe presence of wandering viruses in the body, such as herpes, hepatitis, pathogens of colds. In addition to all of the above, scientists also have a theory about a possible genetic predisposition, as this is indicated by the presence of the same genes in patients.
Horton's disease, the symptoms of which are of the most diverse nature, can show its symptoms from several weeks to several months. Sometimes the development of the disease is accelerated after a viral, infectious or catarrhal disease. Symptoms of the disease can be divided into general, manifestations of vascular damage and a drop in the level of vision. As a rule, the presence of at least one of them determines which doctor to contact.
General symptoms
The manifestation of Horton's disease is an increase in body temperature, frequent and severe headaches, rapid weight loss, fatigue, sleep disorders, pain in the joints and muscles. As for the pain in the head, it can occur both in one part of the skull, and in several at once, and, as a rule, has a pulsating character. Most often, the pain occurs at night and becomes more intense over time. In addition to migraine, patients may experience numbness of the scalp, pain when talking or eating, and discomfort in the face. Pain in the muscles and joints is localized, as a rule, in the area of the shoulders or hips. The nature of joint pain is similar to that of arthritis.
Vascular damage
Vessels in Horton's disease are exposed toseal. Usually they look like nodules, painful and hot to the touch. At the same time, in such vessels there are no signs of the presence of a pulse and blood movement. On the scalp, the presence of seals and swelling is also possible. Moreover, very often the areas of the skin close to the arteries change their color to reddish-burgundy. Edema may occur with Horton's syndrome.
The disease that occurs in the region of the internal carotid artery is particularly dangerous. This is due to the fact that the identification of external symptoms is difficult. Complications of this course of the disease are also associated with the fact that severe damage to a large vessel, not detected in time, can lead to serious negative consequences, such as stroke and hemorrhage.
Falling vision
Another organ that suffers the most in the development of Horton's disease is the eyes. The manifestation of vascular disease is very often associated with increased pressure, pain, bifurcation and other vision abnormalities. This is primarily due to the lack of proper blood circulation in this place. With timely treatment, serious consequences can be avoided, otherwise the patient is threatened with complete atrophy of the optic nerve and subsequent blindness.
Diagnosis
This disease is detected mainly by external clinical examination, as well as the study of test results. When evaluating a patient's condition, special attention is paid to neurological he alth. It is worth considering that this disease is capable of stronglyinfluence the level of vision, so its verification is given an important role. A biopsy from the damaged vessel is taken as a laboratory test, and the patient is assigned ultrasound dopplerography, magnetic resonance or computed tomography of the brain.
Research results
According to the data obtained during the diagnosis, one can judge the stage of the disease and make a decision on treatment. As a rule, the results are complex information obtained after passing the examination and laboratory tests.
As a result of blood sampling, the presence of insufficient blood cells, an increase in the level of leukocytes and an acceleration of erythrocyte sedimentation are established. A complete analysis from a vein usually reveals a change in the ratio of protein fractions of the blood and a decrease in the level of albumin.
When examining vision, doctors pay special attention to establishing its sharpness and the presence of defects and destruction of the inner bottom of the eye.
Biopsy and studies of the cellular material of the damaged vessel make it possible to establish benign changes in the thickness and structure of the vessel in Horton's syndrome. The disease usually occurs in the form of the appearance of granular nodules in the walls of the arteries. Such development cannot but affect the functionality of the vessel itself: over time, its lumen becomes narrower and narrower.
However, there are cases when such changes in the artery or vein are not observed. This may be due to the fact that the defeatvessel has a very point character and is not always amenable to establishment. This is due to the fact that the lesion of the artery is segmental in nature and during the biopsy it is possible to take an unaffected portion of the artery.
In addition, all the described symptoms depend only on the characteristics of the organism of each individual patient, including his age, lifestyle and other factors. Thus, the Association of American Rheumatologists cites statistics indicating that a wide variety of demographic factors greatly influence the course of the disease. They include the age of the patient, especially if it is over 50.
Problems in diagnosing
When establishing the symptoms of Horton's disease, it should also be distinguished from similar diseases, such as arthritis, rheumatism, neuralgia, pathologies of the lymphatic system, systemic vasculitis. This is especially true for the elderly. The course may differ from that in other age groups, since very often changes in the veins and arteries associated with other diagnoses fit the description of Horton's syndrome. The disease is confused, for example, with atherosclerosis. However, the pain in the head in this case is of a completely different nature. In addition, vasculitis is characterized by a much more intense level of erythrocyte sedimentation and more pronounced changes in the walls of blood vessels, which appear during a biopsy. Sometimes these mixed symptoms can cause a problem for the patient which doctor to see.
Treatment
Getting rid of thisdisease is carried out using glucocorticoids. As a rule, at the beginning of treatment, the doctor prescribes therapy with these drugs, which continues for two years. The course is terminated if the patient is completely free of the disease and there are no relapses. The use of corticosteroids has a positive effect on Horton's disease.
Treatment with hormonal drugs is carried out according to the appropriate scheme, taking into account the nuances of the course of the disease. With slow development, the patient is prescribed to take tablets containing prednisolone at the rate of 20 to 80 milligrams per day. With the intensive development of the disease, it is more expedient to use shock therapy with large doses of methylprednisolone. After a month of heavy treatment, a dosage reduction is possible. In this case, every week the dose of the drug is reduced to the maintenance level, which is about 5-7.5 milligrams per day. After two years of treatment, the question of discontinuation of therapy may arise due to the absence of relapses. For the last six months, the patient can be on a maintenance dose of 2-2.5 milligrams of a hormonal drug per day.
However, it is possible that treatment with glucocorticoids does not give the expected effect. In this case, it is advisable to prescribe treatment with cytostatics. Moreover, in addition to hormonal therapy, drugs from the category of anticoagulants, as well as antihistamines, can be prescribed.
Disease prognosis
It should be noted that such a disease threatens the life of the patient, asusually does not. Some rare advanced cases of the course of the disease can lead to visual impairment, up to blindness, as well as to the development of stroke, heart attack and necrosis. However, the disease is treatable in the vast majority of cases. The prognosis for properly selected therapy is mostly favorable. In the absence of relapses in the next two years of the patient's life, they say that, most likely, they will not take place in his later life. Rare complications during treatment can be associated solely with personal intolerance to corticoid therapy in patients. Do not forget the main rule of successful treatment - only a doctor should make a diagnosis! He also has the exclusive right to prescribe treatment.
Since one of the factors in the occurrence of the disease is its viral nature, it is very important to adhere to a he althy lifestyle and harden the body. You should also remember that the likelihood of developing vasculitis is genetically determined, and do not expose yourself to unnecessary risk.
Also, patients are often interested in the question: do they give disability in Horton's disease? As a rule, severe inconvenience during illness can lead to her extradition, since the complex course of the illness, which manifests itself in severe headaches and tearing, does not allow the employee to perform his duties for a long time, including in bright light.
