Rheumatoid vasculitis is one of the manifestations of chronic rheumatoid arthritis, accompanied by damage to the walls of various vessels, from skin capillaries to large arterial or venous trunks. The progression of such vasculitis without proper immediate treatment can lead to aggravation of arthritis and disability of the patient.
Etiological factors
Patients often wonder what kind of disease it is - rheumatoid vasculitis. This ailment is not an independent pathology, but is a special form of rheumatoid arthritis.
The causes of vasculitis in rheumatoid arthritis are not known for certain. However, there are a number of internal conditions that negatively affect the joints and blood vessels and, accordingly, provoke the formation of the disease. These include:
- inflammatory processes in the walls of blood vessels;
- autoimmune reactions that stimulate the growth of the tissue of the synovial articular membranes, which ultimately leads to cartilage and articular deformities;
- decrease in the activity of blood cells (monocytes, macrophages) that synthesize cytokines and support anti-inflammatory reactions;
increase in the synthesis (and, accordingly, increase in the amount in the blood) of immunoglobulins G and M (intrinsic immune rheumatoid factors). A decrease in the concentration of G-immunoglobulin in the blood is a sign of the effectiveness of the treatment
The risk groups for the high probability of rheumatoid vasculitis include male patients with a high concentration of rheumatoid factors in the blood.
Doctors continue to find out the causes of the disease in order to further develop effective etiotropic treatment.
Classification
Rheumatoid vasculitis is divided into several forms:
Vasculitis, accompanied by inflammation in the walls of small (venules, capillaries, arterioles) vessels. At the same time, their walls become thinner, and nutrients and blood easily pass through them. The patient's skin is covered with pink papules, trophic ulcers and rashes
- Digital arteritis. It is characterized by inflammation with subsequent destruction of the walls of the subcutaneous vessels and the formation of blood clots. In this case, clinical manifestations are visualized on the nails, finger phalanges and hands of the patient.
- Vasculitis necrotizing. Accompanied by damage to the vessels of internal organs and damage to the nervous peripheral system.
Clinical manifestations
Symptoms of rheumatoid vasculitis, depending on the stage of the disease, can be non-specific and specific.
Thus, the initial stage of the pathology is characterized by the appearance of non-specific signs:
- headaches (intense);
- numbness of limbs;
- drastic weight loss;
- weakness;
- vision loss;
- hyperthermia to critical numbers;
- fainting;
- joint aches;
small swelling in the temporal region
These signs, as a rule, are precursors of skin manifestations: hemorrhages, blisters, redness, red dots. If the process is not stopped at this stage with the help of therapy, moderate and severe forms of the disease develop. At the same time, skin blisters turn into large blisters, which eventually transform into ulcers and necrosis, most often localized on the limbs.
Characteristic manifestations of rheumatoid vasculitis (see photo above) are numerous rheumatoid nodules that form on the fingers.
In addition, the presence of vasculitis is indicated by:
- sarcoidosis;
- pericarditis;
- peripheral gangrene;
- multiple mononeuritis;
- sclerite;
- damage to the periungual area.
All these pathologies are classic companions of vasculitis, allowing us to speak with confidence about the presence of this pathology in a patient, however, the doctor establishes the final diagnosis only after a thoroughdiagnostics.
Diagnostic measures
In order for the treatment of the disease to be as effective as possible, it is necessary to recognize it at the earliest stages. However, early manifestations of vasculitis are easily confused with other chronic diseases due to their non-specificity. Therefore, doctors resort to differential diagnosis and additional examination methods:
blood test (general and biochemical detailed);
- determination of the concentration of liver enzymes and creatinine;
- urinalysis;
- serological tests.
Back blood test is necessary to rule out infectious diseases. In addition, the patient may be scheduled for CT, ultrasound (duplex), MRI, angiography, radiography.
When conducting differential diagnosis, the following characteristic differences in rheumatic vasculitis are taken into account:
- increased blood levels of C-reactive protein;
- participation in the pathological process of large vascular trunks with the formation of necrotic foci in their walls (the so-called erosive arthritis);
- excessively high concentration of immunoglobulins G and M (rheumatoid factors);
- increased concentrations of immune components of complement C 3, 1 and 4.
Treatment of rheumatoid vasculitis
Therapy appropriate to the patient's condition should be selected by a specialist rheumatologist. Due to the fact that vasculitis is a secondary ailment that develops against the background of RA, it is treated in a complex way. Additional therapeutic measures are carried out if trophic ulcerations have already formed on the patient's body.
Therapy for rheumatoid vasculitis is directed:
- to obligatory achievement of remission;
- maximum reduction in the likelihood of complications;
- maintenance of internal organs and prevention of destructive processes in them.
Typically, doctors use the following treatment regimens:
- intermittent pulse therapy;
- supportive care.
Aggressive therapy (pulse therapy)
The most effective technique used to treat acute manifestations of rheumatoid vasculitis is the combination of Cyclophosphamide + Prednisolone.
"Cyclophosphamide" is an immunosuppressant, "Methylprednisolone" is a representative of the pharmaceutical group of glucocorticosteroid drugs. Enter the patient these drugs intravenously once every two weeks, a course of 6 weeks. In this case, the dosages are: 1 g of "Methylprednisolone" and 15 mg / kg of "Cyclophosphan". After 6 weeks, the frequency of drug administration is increased to 1 time in 3 weeks for a course of 9-12 months. Accurate implementation of the therapeutic scheme allows you to quickly achieve remission of the disease.
Other drugs
High doses of hormones in the treatment of rheumatoid vasculitis, the symptoms of which are described in the corresponding section, are not recommended, as this is very likely to causeunwanted side effects.
Sometimes Chlorambucil is used in short course therapy. Despite its effectiveness in vasculitis, the drug is used in exceptional cases due to the high risk of cancer.
"Methotrexate", belonging to the pharmaceutical group of immunosuppressants, is not used in the treatment of the condition, since its use has a high risk of aggravating symptoms and the occurrence of rheumatoid nodules.
"Cyclophosphamide" significantly reduces inflammation in the vascular wall. Medicine is prescribed in small doses for relapses.
Dipyridamole is prescribed to improve blood flow.
Severe vasculitis and cryoglobulinemia are treated with plasmapheresis.
Supportive treatment is carried out by the introduction of Azathioprine (has a lot of side effects), Pentoxifylline, Dipyridamole, Thalidomide.
Treatment of trophic ulcers
If trophic ulcers appear on the patient's skin, they must be additionally treated. If there is a discharge (icure or pus) in the wound, it is treated with anti-inflammatory external medicines that eliminate pain and accelerate the healing of the defect.
It is forbidden to apply any dressings and bandages to the wound. Doctors advise the use of external ointments with clostridiopeptidase and levomycetin ("Iruxol").
Forecasts
Vasculitis is a serious illness that needs an integrated approach and constant monitoring. Properly selected and timely carried out therapy, including corticosteroids and cytostatics, significantly improves the prognosis of rheumatoid vasculitis and the survival of patients. Thus, such treatment of polyarteritis nodosa provides a five-year survival rate of 78% of patients. The bulk of deaths in this case is recorded during the first year of the disease due to developing ailments of the gastrointestinal tract, heart, central nervous system and kidneys.
Adequate therapy for microscopic polyarteritis guarantees a 5-year survival rate of more than 65% of patients. Most deaths are associated with pulmonary hemorrhage and secondary infections. In addition, the prognosis is determined by the condition of the kidneys.
With Takayasu's arteritis, up to 80% of patients have a 15-year survival rate. Mortality in this pathology occurs as a result of strokes and heart attacks.
Therapy for giant cell arteritis provides a 5-year survival rate of 100% of patients, however, there is a high probability of complications in the form of lesions of the ophthalmic arteries and, as a result, irreversible blindness.
Preventive measures
Rheumatoid vasculitis is a dangerous pathology leading to fragility and subsequent destruction of the vascular wall with the occurrence of hemorrhages, as well as impaired blood supply to various organs and, as a result, their necrosis.
Because adequate prevention plays an important role in supporting not only blood vessels, but also the body in general. Recommended prophylaxis does not require significant efforts from the patient. All you need is:
- avoid excessive sun exposure. It is especially important to protect against excessive solar radiation in patients in whom RV manifests as cutaneous hemorrhages;
- avoid hypothermia;
- avoid excessive exercise;
- eliminate allergenic foods (chocolate, eggs, oranges) and alcohol;
- maintain a positive mental attitude;
- prevent and eradicate chronic infectious foci;
- avoid contact with chemicals;
- treat on time.
