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 aggravate arthritis and disability of the patient.
Etiological factors
Patients are often interested in what kind of disease - 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 proliferation of tissue of the synovial articular membranes, which ultimately leads to cartilage and articular deformities;
- decreased activity of blood cells (monocytes, macrophages) that synthesize cytokines and support anti-inflammatory reactions;
- an increase in the synthesis (and, accordingly, an increase in the amount in the blood) of immunoglobulins G and M (internal 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 an 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 is necrotizing. It is accompanied by damage to the vessels of the internal organs and damage to the nervous peripheral system.
Clinical manifestations
Symptoms of rheumatoid vasculitis depending on the stage of the disease can be nonspecific and specific.
So, the initial stage of the pathology is characterized by the appearance of nonspecific signs:
- headaches (intense);
- numbness of the limbs;
- sudden weight loss;
- weakness;
- decreased vision;
- hyperthermia to critical numbers;
- fainting
- joint aches;
- slight swelling in the temporal region.
These signs, as a rule, are the precursors of skin manifestations: hemorrhages, blisters, redness, red dots. If the process is not stopped at this stage with the help of therapy, a moderate and severe form of the disease develops. At the same time, the skin blisters turn into large blisters, which eventually transform into ulcerations and necrosis, most often localized on the limbs.
The 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;
- scleritis;
- damage to the periungual region.
All these pathologies are the classic satellites of vasculitis, which allow us to confidently talk about the presence of this pathology in the patient, however, the doctor establishes the final diagnosis only after a thorough diagnosis.
Diagnostic measures
In order for the treatment of the disease to be as effective as possible, it is necessary to recognize it at the very early 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;
- Analysis of urine;
- serological tests.
Blood testing is necessary to exclude infectious diseases. In addition, the patient may be assigned to undergo CT, ultrasound (duplex), MRI, angiography, and radiography.
When conducting differential diagnosis, the following characteristic differences of rheumatic vasculitis are taken into account:
- increase in blood 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 the 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 forms against the background of RA, it is comprehensively suited to treatment. Additional therapeutic measures are carried out if trophic ulceration has already formed on the patient's body.
Therapy of rheumatoid vasculitis is directed:
- the mandatory achievement of remission;
- maximum reduction in the likelihood of complications;
- maintaining internal organs and preventing destructive processes in them.
As a rule, doctors use the following treatment regimens:
- intermittent pulse therapy;
- supporting treatment.
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. These drugs are administered to the patient intravenously once every two weeks, for a course of 6 weeks. The dosages are: 1 g of Methylprednisolone and 15 mg / kg of Cyclophosphamide. After 6 weeks, the frequency of administration of drugs is increased to 1 time in 3 weeks with a course of 9-12 months. A clear implementation of the therapeutic regimen allows you to quickly achieve remission of the disease.
Other drugs
High dosages of hormones in the treatment of rheumatoid vasculitis, the symptoms of which are described in the corresponding section, are not recommended, since this is very likely to cause unwanted 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 cancer hazard.
"Methotrexate", which belongs to the pharmaceutical group of immunosuppressants, is not used in the treatment of the condition, since when it is used, there are high risks of exacerbating the symptoms and the occurrence of rheumatoid nodules.
"Cyclophosphamide" significantly reduces inflammatory manifestations in the vascular wall. Small doses are prescribed 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".
Trophic ulcer treatment
In the case of trophic ulcers on the patient’s skin, they must be additionally treated. If there is discharge (in the wound or pus) in the wound, it is treated with anti-inflammatory external drugs that eliminate soreness and accelerate the healing of the defect.
Putting on any wound dressings or bandages is prohibited. Doctors recommend the use of external ointments with clostridiopeptidase and chloramphenicol ("Iruksol").
Forecasts
Vasculitis is a serious ailment that needs an integrated approach and constant monitoring. Correctly selected and timely treatment, including corticosteroids and cytostatics, significantly improves the prognosis of rheumatoid vasculitis and patient survival. Thus, such treatment of polyarteritis nodosa provides five-year survival of 78% of patients. The bulk of deaths 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 of microscopic polyarteritis is guaranteed 5-year survival 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 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.
The therapy of 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 damage to the ocular arteries and, as a result, irreversible blindness.
Preventative 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 a violation of the blood supply to various organs and, as a result, their necrosis.
Therefore, adequate prevention plays an important role in supporting not only blood vessels, but also the body in general. Recommended prophylaxis does not require significant effort from the patient. It is only necessary:
- avoid excessive insolation. It is especially important to protect against excess solar radiation in patients in whom RV is manifested by cutaneous hemorrhages;
- avoid hypothermia;
- avoid excessive physical exertion;
- exclude the consumption of allergenic foods (chocolate, eggs, oranges) and alcohol;
- maintain a positive psychological attitude;
- prevent the appearance and eradicate chronic infectious foci;
- Avoid contact with chemicals
- take therapy courses on time.