Not to be confused with arthritis.
| Arteritis |
| Classification and external resources |
| Specialty |
rheumatology |
| ICD-10 |
I77.6, M31 |
| ICD-9-CM |
447.6 |
| DiseasesDB |
13750 |
| MeSH |
D001167 |
|
[edit on Wikidata]
|
Arteritis is the inflammation of the walls of arteries,[1] usually as a result of infection or autoimmune response. Arteritis, a complex disorder, is still not entirely understood.[2] Arteritis may be distinguished by its different types, based on the organ systems affected by the disease.[2] A complication of arteritis is thrombosis, which can be fatal. Arteritis and phlebitis are forms of vasculitis.
Contents
- 1 Types
- 1.1 Giant cell arteritis
- 1.2 Takayasu arteritis
- 1.3 Temporal arteritis
- 2 Symptoms
- 3 Diagnosis
- 4 Treatment
- 5 References
Types
Arteritis may be primary or secondary to some other disease process. The primary types are:
| Comparison of major types of arteritis |
| Arteritis |
Affected organs |
Histopathology |
| Takayasu arteritis |
Large vessels,[3] including aorta and arch branches[4] |
Histiocytes, giant cells[4] |
| Giant cell arteritis, also often called temporal arteritis (although they differ slightly) |
Superficial temporal artery, other medium- and large-sized vessels,[5] e.g. those supplying the head, eyes and optic nerves |
Lymphocytes, macrophages, and multinucleated giant cells[5] |
| Polyarteritis nodosa |
Medium-sized vessels, CNS, PNS damage, kidneys, gastrointestinal tract, skeletal muscle, heart[4] |
Neutrophils, fibrinoid necrosis[4] |
An example of a secondary arteritis is arteritis caused by infection with the fungal pathogen Candida albicans.[6]
Giant cell arteritis
Giant cell arteritis contains two different types of arteritides that are almost indistinguishable from one another.[2] It includes two types,e temporal arteritis and Takayasu arteritis. Both types contain an occupancy of medium- and larger-sized arteries which are categorized based on the infiltration of the giant cells.[2]
Takayasu arteritis
This type of arteritis is most common in females, with a median age of 25 years.[7] Takayasu arteritis is more common in women of Asian descent who are in their reproductive years.[7] However, over the past decades, its incidence in Africa, Europe, and North America has been increasing.[7] Takayasu arteritis is an inflammatory disease that mainly affects the larger vessels such as the aorta and its surrounding branches.[7] Research focused on Takayasu arteritis in the western parts of the world remains limited. An estimation suggests that, each year, the number of cases per million people is 2.6.[8]
Temporal arteritis
Temporal arteritis, the second type of giant cell arteritis, is also a chronic, inflammatory disease involving mid- to large-sized arteries.[9] Temporal arteritis has a higher incidence in people of Scandinavian descent.[9] However, the incidence rate differs based on population, region and races.[9] Temporal arteritis is not uncommon in North America.[9] The incidence rate is around 0.017% for individuals over 50 years of age.[9]
Symptoms of temporal arteritis are classified as specific and nonspecific.[9]
Nonspecific symptoms:[9]
- Headache
- Low grade fever
- Sweating
- Anorexia (loss of appetite)
- Weight loss
- General malaise
Specific symptoms:[9]
- Claudication of the jaw
- Engorged, tender vessels
Specific symptoms usually develop in the advanced stages of temporal arteritis.[9]
Polyarteritis nodosa of unknown mechanism can cause testiscular pain. It is often associated with aneurysms and Hepatitis B.
Symptoms
Symptoms of general arteritis may include:[3]
- Inflammation
- Fever
- Increased production of red blood cells (erythrocytes)
- Limping
- Reduced pulse
Diagnosis
Diagnosis of arteritis is based on unusual medical symptoms.[10] Similar symptoms may be caused by a number of other conditions, such as Ehlers-Danlos syndrome and Marfan syndrome (both heritable disorders of connective tissue), tuberculosis, syphilis, spondyloarthropathies, Cogans’ syndrome, Buerger's, Behcet's, and Kawasaki disease.[10] Various imaging techniques may be used to diagnose and monitor disease progression. Imaging modalities may include direct angiography, magnetic resonance angiography, and ultrasonography.[10]
Angiography is commonly used in the diagnosis of Takayasu arteritis,[10] especially in the advanced stages of the disease, when arterial stenosis, occlusion, and aneurysms may be observed.[10] However, angiography is a relatively invasive investigation, exposing patients to large doses of radiation,[10] so is not recommended for routine, long-term monitoring of disease progression in patients with Takayasu arteritis.[10]
Computed tomography angiography can determine the size of the aorta and its surrounding branches, and can identify vessel wall lesions in middle to late stages of arteritis.[10] CTA can also show the blood flow within the blood vessels.[10] Like angiography, CTA exposes patients to high dosages of radiation.[10]
Magnetic resonance angiography is used to diagnose Takayasu arteritis in the early stages, showing changes such as the thickening of the vessel wall.[10] Even small changes may be measured, making MRA a useful tool for monitoring disease progression without exposing patients to the radiation of direct angiography or CTA.[10] MRA is an expensive investigation, and shows calcification of the aorta and distal branches less clearly than other imaging methods.[10]
Ultrasonography is an ideal method of diagnosing patients in early stages of arteritis when inflammation in the vessel walls occurs.[10] It can also show the blood flow within the blood vessels.[10] Ultrasonography is a popular first-line investigation for diagnosis because it is relatively quick, cheap, noninvasive, and does not expose patients to radiation.[10] It is also used for long-term monitoring of disease progression in Takayasu arteritis. Not all vascular lesions are visible on ultrasound, and the accuracy of the scan depends, to some extent, on the person reading the scan, as the results are observed in real time.[10]
Treatment
Medications
The first-line treatment for arteritis is oral glucocorticoid (steroid) medication, such as prednisone, taken daily for a period of three months.[3] After this initial phase, the medication may be reduced in dose or frequency, e.g. every other day, if possible.[3] If the disease worsens with the new treatment schedule, a cytotoxic medication may be given, in addition to the glucocorticoid.[3] Commonly used cytotoxic agents include azathioprine, methotrexate, or cyclophosphamide.[3] The dose of glucocorticoid medication may be decreased if response to treatment is good.[3] This medication may be reduced gradually once the disease becomes inactive, slowly tapering the dose (to allow the body time to adjust) until the medication may be stopped completely.[3] Conversely, if the disease remains active, the medication will need to be increased.[3] After six months, if the medication cannot be reduced in frequency to alternate days, or if in 12 months the medications cannot be stopped completely, then treatment is deemed to have failed.[3]
Pulsed therapy is an alternative method of administering the medications above, using much higher doses over a short period of time (a pulse), to reduce the inflammation within the arteries. Methylprednisolone, a glucocorticoid, is often used for pulse therapy; cyclophosphamide is an alternative. This method has been shown to be successful for some patients.[11] Immunosuppressive pulse therapy, such as with cyclophosphamide, has also demonstrated relief of symptoms associated with arteritis.[12]
References
- ^ "Arteritis" at Dorland's Medical Dictionary
- ^ a b c d Hollier, L. H. (1 January 1989). "Arteritis". Perspectives in Vascular Surgery and Endovascular Therapy. 2 (1): 1–8. doi:10.1177/153100358900200101.
- ^ a b c d e f g h i j Gail S. Kerr, Claire W. Hallahan, Joseph Giordano, Randi Y. Leavitt, Anthony S. Fauci, Menachem Rottem, Gary S. Hoffman; Takayasu Arteritis. Annals of Internal Medicine. 1994 Jun;120(11):919-929.
- ^ a b c d Stevens & Lowe: Pathology. At Fleshandbones.com
- ^ a b eMedicine Specialties > Temporal Arteritis Author: Christopher H Lee, MD. Coauthor(s): Jean Marie Hammel, MD. Updated: Sep 8, 2009
- ^ Nagi-Miura N, Harada T, Shinohara H, et al. (Jun 2006). "Lethal and severe coronary arteritis in DBA/2 mice induced by fungal pathogen, CAWS, Candida albicans water-soluble fraction". Atherosclerosis. 186 (2): 310–20. PMID 16157343. doi:10.1016/j.atherosclerosis.2005.08.014.
- ^ a b c d Kerr, Gail S.; Claire W. Hallahan; Joseph Giordano; Randi Y. Leavitt; Anthony S. Fauci; Menachem Rottem; Gary S. Hoffman (June 1994). "Takayasu Arteritis. Annals of Internal Medicine". 120 (11): 919–929.
- ^ Kerr, Gail S; Claire W. Hallahan; Joseph Giordano; Randi Y. Leavitt; Anthony S. Fauci; Menachem Rottem; Gary S. Hoffman (June 1994). "Takayasu Arteritis. Annals of Internal Medicine". 120 (11): 919–929.
- ^ a b c d e f g h i Chen, Chun-Hsiung; Kung, Shih-Ya; Tsai, Ying-Yang; Liao, Hsien-Tzung; Chou, Chung-Tei; Huang, De-Feng (2005). "Temporal Arteritis". Journal of the Chinese Medical Association. 68 (7): 333–335. PMID 16038374. doi:10.1016/S1726-4901(09)70170-4.
- ^ a b c d e f g h i j k l m n o p q Wen, Dan; Du, Xin; Ma, Chang-Sheng (1 December 2012). "Takayasu Arteritis: Diagnosis, Treatment and Prognosis". International Reviews of Immunology. 31 (6): 462–473. PMID 23215768. doi:10.3109/08830185.2012.740105.
- ^ Chevalet, P; Barrier, J. H.; Pottier, P; Magadur-Joly, G; Pottier, M. A.; Hamidou, M; Planchon, B; El Kouri, D; Connan, L; Dupond, J. L.; De Wazieres, B; Dien, G; Duhamel, E; Grosbois, B; Jego, P; Le Strat, A; Capdeville, J; Letellier, P; Agron, L (2000). "A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: A one year follow-up study of 164 patients". The Journal of rheumatology. 27 (6): 1484–91. PMID 10852275.
- ^ Bose, P. (29 November 2012). "TAKAYASU ARTERITIS". Journal of Neurology, Neurosurgery & Psychiatry. 83 (Suppl 2): A1–A1. doi:10.1136/jnnp-2012-304200a.2.
|
Cardiovascular disease (vessels) (I70–I99, 440–456)
|
Arteries, arterioles
and capillaries |
| Inflammation |
- Arteritis
- Buerger's disease
|
| Peripheral artery disease |
| Arteriosclerosis |
- Atherosclerosis
- Foam cell
- Fatty streak
- Atheroma
- Intermittent claudication
- Critical limb ischemia
- Monckeberg's arteriosclerosis
- Arteriolosclerosis
- Hyaline
- Hyperplastic
- Cholesterol
- LDL
- Oxycholesterol
- Trans fat
|
| Stenosis |
- Carotid artery stenosis
- Renal artery stenosis
|
| Other |
- Aortoiliac occlusive disease
- Degos disease
- Erythromelalgia
- Fibromuscular dysplasia
- Raynaud's phenomenon
|
|
Aneurysm / dissection /
pseudoaneurysm |
- torso: Aortic aneurysm
- Abdominal aortic aneurysm
- Thoracic aortic aneurysm
- Aneurysm of sinus of Valsalva
- Aortic dissection
- Coronary artery aneurysm
- head / neck
- Intracranial aneurysm
- Intracranial berry aneurysm
- Carotid artery dissection
- Vertebral artery dissection
- Familial aortic dissection
|
| Vascular malformation |
- Arteriovenous fistula
- Arteriovenous malformation
- Telangiectasia
- Hereditary hemorrhagic telangiectasia
|
| Vascular nevus |
- Cherry hemangioma
- Halo nevus
- Spider angioma
|
|
| Veins |
| Inflammation |
|
Venous thrombosis /
Thrombophlebitis |
- primarily lower limb
- abdomen
- Hepatic veno-occlusive disease
- Budd–Chiari syndrome
- May–Thurner syndrome
- Portal vein thrombosis
- Renal vein thrombosis
- upper limb / torso
- Mondor's disease
- Paget–Schroetter disease
- head
- Cerebral venous sinus thrombosis
- Post-thrombotic syndrome
|
| Varicose veins |
- Gastric varices
- Portacaval anastomosis
- Caput medusae
- Esophageal varices
- Hemorrhoid
- Varicocele
|
| Other |
- Chronic venous insufficiency
- Chronic cerebrospinal venous insufficiency
- Superior vena cava syndrome
- Inferior vena cava syndrome
- Venous ulcer
|
|
| Arteries or veins |
- Angiopathy
- Macroangiopathy
- Microangiopathy
- Embolism
- Pulmonary embolism
- Cholesterol embolism
- Paradoxical embolism
- Thrombosis
- Vasculitis
|
| Blood pressure |
| Hypertension |
- Hypertensive heart disease
- Hypertensive emergency
- Hypertensive nephropathy
- Essential hypertension
- Secondary hypertension
- Renovascular hypertension
- Benign hypertension
- Pulmonary hypertension
- Systolic hypertension
- White coat hypertension
|
| Hypotension |
|
|
|
Systemic connective tissue disorders (M32–M36, 710)
|
| General |
| Systemic lupus erythematosus |
- Drug-induced SLE
- Libman–Sacks endocarditis
|
| Inflammatory myopathy |
- Myositis
- Dermatopolymyositis
- Dermatomyositis/Juvenile dermatomyositis
- Polymyositis* Inclusion body myositis
|
| Scleroderma |
- Systemic scleroderma
- Progressive systemic sclerosis
- CREST syndrome
|
- Overlap syndrome / Mixed connective tissue disease
|
|
| Other hypersensitivity/autoimmune |
|
| Other |
- Behçet's disease
- Polymyalgia rheumatica
- Eosinophilic fasciitis
- Eosinophilia–myalgia syndrome
- fibrillin
- Marfan syndrome
- Congenital contractural arachnodactyly
|
|
Inflammation
|
| Acute |
| Plasma-derived mediators |
- Bradykinin
- complement
- coagulation
- Factor XII
- Plasmin
- Thrombin
|
| Cell-derived mediators |
| preformed: |
- Lysosome granules
- biogenic amines
|
| synthesized on demand: |
- cytokines
- eicosanoids
- Leukotriene B4
- Prostaglandins
- Nitric oxide
- Kinins
|
|
|
| Chronic |
- Macrophage
- Epithelioid cell
- Giant cell
- Granuloma
|
| Processes |
| Traditional |
- Rubor
- Calor
- Tumor
- Dolor
- Functio laesa
|
| Modern |
- Acute-phase reaction/Fever
- Vasodilation
- Increased vascular permeability
- Exudate
- Leukocyte extravasation
- Chemotaxis
|
|
Specific
locations |
|
