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  Vasculitis  
 
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Conditions that suggest it | Contributing risk factors | Recommendations

 

Vasculitis is an inflammation of the blood vessels. It is commonly associated with diseases such as SLE, scleroderma, ulcerative colitis, rheumatoid arthritis and dermatomyositis. Drugs, complement deficiencies, viral, bacterial and protozoan infections have all been implicated. Immune complexes are formed when antigens bind to antibodies. If not excessive, and assuming a healthy immune response, these complexes are usually cleared from the circulation by the phagocytic system. These responses are usually delayed, occurring hours or even days after exposure to the antigen, from whatever source. When these complexes persist in the circulation, their interaction with platelets result in the release of vasoactive amines. Vasoactive amines cause increased vessel permeability, platelet aggregation (clotting) and initiation of the arachidonic acid cascade (inflammation). These immune complexes can also settle out within the postcapillary venules, with subsequent tissue inflammation, irritation and damage by complement activation, more inflammatory cells coming to the area and destructive lysosomal enzyme release.

Liver diseases such as chronic hepatitis, alcoholic cirrhosis and biliary cirrhosis are associated with lowered hepatic clearance and increased circulating immune complexes.

Treatment revolves around the removal or reduction of circulating immune complexes, dampening down the inflammatory response, stabilising lysosomal cell membranes and improving circulation to damaged tissues.

Sometimes drugs, hidden infections and food allergens increase the level of circulating immune complexes. Exposure to these should be reduced. Avoid temperature extremes, as cold can precipitate immune complexes.

Vasculitis can cause many different symptoms, depending upon what tissues are involved and the severity of the tissue damage. Some patients are not ill and only notice occasional spots on their skin. Others are very ill with systemic symptoms and major organ damage. A list of symptoms based on the tissues in which vasculitis occurs include:

Systemic symptoms
Fever, generally feeling bad ("malaise"), muscle and joint pain, poor appetite, weight loss, and fatigue. This set of complaints can occur in many illnesses and is not specific to vasculitis.

Skin
Red or purple dots ("petechiae"), usually most numerous on the legs. When the spots are larger, about the size of the end of a finger, they are called "purpura." Some look like large bruises. These are the most common vasculitis skin lesions, but hives, itchy lumpy rash, and painful or tender lumps can occur. Areas of dead skin can appear as ulcers (especially around the ankles), small black spots at the ends of the fingers or around the fingernails and toes ("nail fold infarcts"), or gangrene of fingers or toes.

Joints
Aching in joints and a frank arthritis with pain, swelling and heat in joins. Deformities resulting from this arthritis are rare.

Brain
Vasculitis in the brain can cause many problems, from mild to sever. They include headaches, behavioral disturbances, confusion, seizures, and strokes.

Peripheral Nerves
Peripheral nerve symptoms may include numbness and tingling (usually in an arm or a leg, or in areas which would be covered by gloves or socks), loss of sensation or loss of strength (especially in the feet or hands).

Intestines
Inadequate blood flow in the intestines can cause crampy abdominal pain and bloating. If areas in the wall of the intestine develop gangrene, blood will appear in the stool. If the intestinal wall develops a hole (called a "perforation"), surgery may be required.

Heart
Vasculitis in the coronary arteries is unusual in lupus. If it occurs, it can cause a feeling of heaviness in the chest during exertion ("angina"), which is relieved by rest. Heart attacks rarely occur as a result of vasculitis.

Lungs
Vasculitis in this tissue can cause pneumonia-like attacks with chest x-ray changes that look like pneumonia, and symptoms of fever and cough. Occasionally, inflammation can lead to scarring of lung tissue with chronic shortness of breath.

Kidneys
Vasculitis is not common in kidneys of people with lupus, even those who have lupus nephritis. It may not cause any symptoms, although most patients with renal vasculitis have high blood pressure.

Eyes
Vasculitis involving the small blood vessels of the retina can occur in lupus. The retina is a tissue at the back of the eye which contains cells that have to be activated to form a visual image. Sometimes, vasculitis of the eyes causes no symptoms. Usually, however, there is visual blurring which comes on suddenly and stays, or a person may even lose a portion of their vision. In other non-lupus types of vasculitis, such as temporal arteritis, there is sudden loss of part or all of the vision in one eye, usually accompanied by sever headache.
 

 
 

Conditions that suggest Vasculitis:
 
 
Lab Values  Eosinophilia

Symptoms - Cardiovascular

  History of/having vasculitis

Counter-indicators:
  Absence of vasculitis
 
 

Risk factors for Vasculitis:
 
 
Autoimmune  Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
 In the vasculitis caused by lupus, the antigens causing the immune complexes are often not known. In some cases, the complexes contain DNA and anti-DNA antigens, or Ro (also called SS-A) and anti-Ro antigens. Another antibody, ANCA (anti-neutrophil cytoplasm antibody), can cause vasculitis in some individuals.

Infections

  Lyme Disease
 
 

Recommendations for Vasculitis:
 
 
Lab Tests/Rule-Outs  Digestive Enzymes / (Trial)
 Decreasing circulating immune complexes may be accelerated by breaking them down with the use of trypsin, chymotrypsin and pancreatin. These enzymes must be given at least one hour before meals. One of the basic concepts in systemic enzyme therapy is that all kinds of inflammatory processes respond to enzymes. Hydrolytic enzymes directly attack the microclots breaking open the clogged vessels and reestablishing circulation. By restoring normal blood flow, post inflammatory pain and edema are reduced more rapidly.

Nutrient

  Essential Fatty Acids
 An essential fatty acid Omega-6/Omega-3 imbalance or deficiency can contribute to inflammation, which is part of the problem in vasculitis.

Vitamins

  Vitamin E
 A membrane's lipid bilayers is high in polyunsaturated fatty acids which are subject to oxidation. Vitamin E's function in maintaining membrane integrity might be attributed to its prevention of the membrane damage. It has been hypothesized vitamin E protects the lysosomal membranes from rupturing and destroying the cells.

  Bioflavonoids
 Due to its antioxidant effect, quercetin can inhibit inflammatory processes mediated by "leukotrienes" (inflammatory agents a thousand times more powerful than histamines), hyaluronidase (collagen-destroying enzymes), and lysosomal enzymes (other promoters of localized inflammation).
 
 


KEY
Weak or unproven link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help







GLOSSARY

Allergen:  A substance that is capable of producing an allergic response in the body.

Angina:  Angina pectoris. Severe, restricting chest pain with sensations of suffocation caused by temporary reduction of oxygen to the heart muscle through narrowed diseased coronary arteries.

Antibody:  A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Antigen:  A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Cytoplasm:  The inner substance of a cell contained within the cell membrane other than the nucleus.

Dermatomyositis:  A diffuse connective tissue disease.

DNA:  Deoxyribonucleic acid, the large molecule that is the main carrier of genetic information in cells. DNA is found mainly in the chromosomes of cells.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Hepatitis:  Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.

Malaise:  A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.

Nephritis:  Kidney inflammation.

Protozoan:  (Plural: Protozoa) Any one of a large group of one-celled (unicellular) animals, including amoebas. They are microorganisms that differ from bacteria in that they are larger and possess a nucleus surrounded by a membrane. Several species of protozoa can be transmitted through water and cause disease in humans, including Giardia, Cryptosporidium, Cyclospora, Entamoeba and Isospora. One distinguishing characteristic of protozoa is that when released from the human body through feces they are present in an encysted (dormant) form. These cysts have a protective layer that surrounds them and keeps chemicals from penetrating them. Therefore, chlorine disinfection does not kill the protozoan cysts.

Purpura:  Bleeding into the tissues directly beneath skin or mucous membranes yielding a bruise or many red or purple petechia (flat, pin-head sized spots).

Retina:  A 10-layered, frail nervous tissue membrane of the eye, parallel with the optic nerve. It receives images of outer objects and carries sight signals through the optic nerve to the brain.

Rheumatoid Arthritis:  A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

Seizure:  While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.

Ulcer:  Lesion on the skin or mucous membrane.

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.

Urticaria:  Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergies to foods or medications as well as viral illness are frequent causes of acute urticaria which usually lasts only a few hours but may last up to 6 weeks. Chronic urticaria (lasting more than 6 weeks) is more complex, given the vast number of potential triggers. Symptoms include sudden onset; initial itching; then swelling of the surface of the skin into red or skin-colored welts (wheals) with clearly defined edges; welts turn white on touching; new welts develop when the skin is scratched; usually disappear within minutes or hours. Welts enlarge, change shape, spread or join together to form large flat raised areas.

Vasculitis:  Inflammation and necrosis of blood vessels, including arteries, veins and capillaries. The damage may be due to infectious agents, mechanical trauma, radiation or toxins; often no specific causative factor is identified. It involves immune mechanisms such as deposition of circulating immune complexes and direct attack by circulating antibodies