Vasculitides are a large and heterogeneous group of diseases, which have in common an inflammation of the blood vessels, which narrow and cause a lack of blood supply to the tissues.
Causes of vasculitis
There are numerous causes of vasculitis. They are classified into two types: primary, when the origin of the disease is unknown, and secondary, when they are derived from other underlying diseases or from the administration of drugs.
Primary forms of vasculitis
Primary forms are of unknown cause, rare and usually more severe. The most common primary vasculitis, affecting approximately one in 500 people over the age of 50, is temporal giant cell arteritis. The most frequent symptoms are headache of recent onset, jaw pain when chewing, fever, loss of appetite, fatigue, musculoskeletal pain and the possibility of ocular complications. It is sometimes associated with polymyalgia rheumatica, a syndrome characterized by pain and stiffness in the shoulder girdle and pelvic girdle, which incapacitate the patient to perform basic actions such as combing the hair or getting up from a seat.
The following conditions are also primary forms of vasculitis, although much less frequent than the previous one:
- Behçet’s disease: its most common manifestations are cutaneous, ocular involvement and aphthous ulcers of the mouth and genitals.
- Takayasu’s arteritis: also known as “pulseless disease”, it is a disease more frequent in Eastern countries and produces vascular alterations of large vessels.
- Buerger’s disease: appears in smokers and has aggressive vascular manifestations, generally in the lower limbs.
- Kawasaki disease: it is a disease that affects children, compromising the coronary arteries of the heart.
- Panarteritis nodosa: in this disease there is inflammation of the peripheral nervous system, testicles and skin involvement is frequent.
- Granulomatosis with polyangiitis: also known as Wegener’s disease, it causes involvement of the facial sinuses, lungs and kidneys.
- Microscopic polyangiitis: mainly affects the lungs and kidneys.
- Eosinophilic granulomatosis with polyangiitis: also known as Churg-Strauss syndrome, it is characterized by bronchial asthma and a pronounced increase of eosinophils in the blood.
All of them have specific peculiarities, although they all have in common the ability to produce various clinical manifestations, such as general symptoms, fever, thinning, skin purpura and the possibility of affecting numerous vital organs, such as the heart, lungs, nervous system and kidneys.
In the laboratory, primary vasculitides usually present anemia, increased erythrocyte sedimentation rate and CRP, with frequent alterations in the urinary sediment and elevated urea and creatinine. An analytical finding very suggestive of some types of primary vasculitis is the positivity of specific antibodies, known as ANCAs.
It should be noted that, due to the possibility of producing so many and varied clinical manifestations, these processes can be confused with numerous infectious and neoplastic diseases, so it is very important to make the diagnosis as early as possible, as they require early, complex and specific immunosuppressive treatment.
Secondary forms of vasculitis
The so-called secondary vasculitis are more frequent than the primary forms and are caused by a wide group of infectious diseases (hepatitis, HIV, parvovirus, Epstein Barr virus, cytomegalovirus, meningococcus, protozoa, fungi, etc.), neoplastic diseases (leukemias, lymphomas, lung, digestive and genitourinary cancers), and immune-based or autoimmune diseases (rheumatoid arthritis, lupus erythematosus, Sjögren’s syndrome, ulcerative colitis, Crohn’s disease, cryoglobulinemia, etc.). ). Secondary vasculitis can also be caused by taking various drugs (antibiotics/sulfonamides, antihypertensives, antiarrhythmics, antiepileptics, analgesics, anti-inflammatory drugs, etc). The most common symptomatology of these forms of secondary vasculitis is the appearance of cutaneous purpura.
One of the most frequent secondary vasculitis is Schönlein Henoch purpura, which affects more children and adolescents, producing cutaneous purpura, musculoskeletal and abdominal pain. It usually has a benign course, although renal complications may arise.
The prognosis and evolution of secondary vasculitis will vary depending on the originating disease, although generally it does not require such an aggressive treatment as in the case of primary vasculitis.
For more information, consult a specialist in Internal Medicine.