One of the most common and hazardous vascular diseases is Horton's disease. How dangerous it is and how it is treated will be described here.
Nature of the disease
Horton's disease is also known under such names 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 infects veins, arteries, and other large blood vessels. Very often this disease is localized within the membrane of the carotid artery.
This syndrome is named after the doctor Horton. The disease was discovered in America in the thirties of the twentieth century. Statistics show that temporal arteritis is most often found in northern Europe and the Scandinavian countries. As a rule, the disease affects people of retirement age, and women get sick almost twice as many 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 the artery lesion with vasculitis. Moreover, the development of this disease may depend on the presence of vagus viruses in the body, such as herpes, hepatitis, and causative agents 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 very diverse, can manifest itself from a few weeks to several months. Sometimes the development of the disease accelerates 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.
Common symptoms
The manifestation of Horton's disease is an increase in body temperature, frequent and severe headaches, rapid weight loss, fatigue, sleep disorders, joint and muscle pain. As for 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, pain occurs at night and only intensifies over time. In addition to migraine, patients may be disturbed by numbness of the scalp, pain when talking or eating, unpleasant sensations in the face. Muscle and joint pains are localized, usually in the shoulders or hips. The nature of joint pain is similar in nature to arthritis.
Vascular damage
The vessels in Horton's disease are densified. Usually they look like nodules, painful and hot to the touch. Moreover, in such vessels there are no signs of a pulse and blood movement. On the scalp is also possible the presence of seals and swelling. Moreover, very often areas of the skin adjacent to the arteries change their color to reddish-burgundy. Perhaps the appearance of edema in Horton's syndrome.
A 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 on time, can lead to serious negative consequences, such as stroke and hemorrhage.
Vision loss
Another organ that suffers the most during 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 deviations in vision. 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 at risk of complete atrophy of the optic nerve and subsequent blindness.
Diagnostics
This disease is detected mainly through an external clinical examination, as well as the study of test results. When assessing the condition of the patient, special attention is paid to neurological health. It is worth considering that this disease can greatly affect the level of vision, therefore, an important role is assigned to its verification. As laboratory tests, a biopsy is taken from a damaged vessel, and ultrasound dopplerography, magnetic resonance imaging or computed tomography of the brain are also prescribed to the patient.
Research results
According to the data obtained during the diagnosis, it is possible to 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 insufficiency of blood cells, an increase in the level of leukocytes and an acceleration of the sedimentation of red blood cells are established. A complete analysis of the 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 severity and the presence of defects and destruction of the inner fundus of the eye.
Biopsies 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 proceeds 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 times when such changes in the artery or vein are not observed. This can be explained by the fact that the lesion of the vessel has a very pointed character and is not always amenable to establishment. This is due to the fact that the damage to 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 body of each individual patient, including on his age, lifestyle and other factors. Thus, the Association of American Rheumatologists gives statistics indicating that the course of the disease is very strongly influenced by a wide variety of demographic factors. They include the age of the patient, especially if he exceeds 50 years.
Diagnostic problems
When identifying the symptoms of Horton's disease, it should also be distinguished with 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 of other age groups, since very often changes in veins and arteries associated with other diagnoses fit the description of Horton's syndrome. The disease is confused, for example, with atherosclerosis. However, 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 are manifested by biopsy. Sometimes such mixed symptoms can cause the patient to question which doctor to contact.
Treatment
Getting rid of this ailment is carried out using glucocorticoids. As a rule, at the beginning of treatment, the doctor ascribes therapy of these drugs, which lasts for two years. The course is terminated if the patient begins to completely get rid of the disease and there is no relapse. 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 prednisone in the calculation of 20 to 80 milligrams per day. With the intensive development of the disease, it is more advisable to apply shock therapy with large doses of methylprednisolone. After a month of plentiful treatment, a dosage reduction is possible. In this case, every week the dose of the drug is reduced to a maintenance level, which is about 5-7.5 milligrams per day. After two years of treatment, a question may arise about the abolition of therapy due to the absence of relapse. For the past six months, the patient may be on a maintenance dose of 2-2.5 milligrams of a hormonal drug per day.
However, a situation is possible where treatment with glucocorticoids does not give the expected effect. In this case, it is advisable to prescribe treatment with cytostatics. Moreover, in addition to hormone therapy, drugs from the category of anticoagulants, as well as antihistamines, can be prescribed.
Disease prognosis
It should be noted that such a disease does not pose a threat to the life of the patient. Certain rare neglected 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 can be treated in the vast majority of cases. Forecasts with correctly selected therapy are mostly favorable. In the absence of relapse in the next two years of the patient’s life, they say that, most likely, they will not take place in his future life. Rare complications during treatment may be associated exclusively with personal intolerance to patients with corticoid therapy. Do not forget the main rule of successful treatment - only a doctor should make a diagnosis! He has the exclusive right to prescribe treatment.
Since one of the factors of the onset of the disease is its viral nature, it is very important to adhere to a healthy lifestyle and conduct hardening of the body. It should also be remembered that the likelihood of developing vasculitis is genetically determined and not expose yourself to unnecessary risk.
Also, patients are often interested in the question: do disability in Horton's disease give? As a rule, severe inconvenience in the disease can lead to its delivery, since the complex course of the disease, which manifests itself in severe headaches and tearing, does not allow the employee to fulfill his duties for a long time, including in bright light.