Arteritis

The inflammation of arteries is called arteritis ( Pl. Arteritis ) .

The cause of acute arteritis, which is rare today, can be an acute infection, e.g. B. be typhoid. Chronic forms are also observed in HIV infections, tuberculosis and syphilis . Essentially, however, these are diseases of the rheumatic type . The best- known example is temporal arteritis in the context of polymyalgia rheumatica . Two special forms of arteritis cannot be clearly classified: endangiitis obliterans and Behçet's disease . Viral diseases such as equine arteritis in horses or arteritis of unknown cause such as meningitis arteritis in dogs occur in animals .

Rheumatic causes

The rheumatic arteritis is one of the vasculitis . Since capillaries and venous vessels are often also affected, it is usually referred to as angiitis. In addition to the primary vasculitis, in which the inflammation of the vessels is assumed to be the cause of the disease, the secondary vasculitis is another underlying disease, usually also rheumatic, such as B. collagenosis or rheumatoid arthritis .

Depending on the histopathological picture, they can be classified as (granulomatous) giant cell arteritis, as necrotizing vasculitis and as leukocytoclastic vasculitis. More common, however, is the classification according to the size of the predominantly affected vessels, which emerged from a consensus conference in Chapel Hill, America in 1992:

• Great vessel vasculitis :
  • Giant cell arteritis and the closely related polymyalgia rheumatica with temporal arteritis (synonym: cranial arteritis, Horton's disease): granulomatous arteritis of the large stem vessels, often the temporal artery is also affected; rarely before the age of 50.
  • Takayasu arteritis : granulomatous inflammation of the aorta and the large arterial trunks. Mostly occurring before the age of 50.
• Vasculitis of the medium-sized vessels
  • Panarteritis nodosa : necrotizing vasculitis of small and medium-sized vessels
  • Kawasaki syndrome : mostly acute in children, with a typical rash ("strawberry tongue"), fever and swelling of the lymph nodes.
• Vasculitis of the small vessels
  • Wegener's granulomatosis : granulomatous vasculitis, mostly kidneys and lungs are affected, with glomerulonephritis
  • Churg-Strauss syndrome : granulomatous vasculitis, mostly of the respiratory tract (respiratory system), with eosinophilia and asthma .
  • Cutaneous cytoclastic angiitis
  • Henoch-Schönlein purpura : Vasculitis in young children, mostly joints, kidneys, gastrointestinal tract and skin (purpura) are affected, often after a respiratory tract infection .
  • microscopic polyangiitis : necrotizing vasculitis, mostly of the respiratory tract and kidneys, with glomerulonephritis

Typical of primary vasculitis is the detection of antineutrophil cytoplasmic antibodies ( ANCA ), with the exception of some small vessel vasculitis. Treatment is usually immunosuppressive. In addition, supportive measures are often required, e.g. B. intermittent dialysis for kidney failure. The diagnosis, which is often very delayed, is important and difficult.

See also

• Melkersson-Rosenthal syndrome

further reading

• HJ Hettenkofer: Rheumatology . Thieme-Verlag, Stuttgart 1998, ISBN 3-13-657803-1 .

Individual evidence

1. ↑ JC Jennette et al.: Nomenclature of systemic vasculitides. In: Arthr Rheum. 1994; 37, p. 187.
2. ↑ CM Weyand, JJ Goronzy: Medium- and Large-Vessel Vasculitis. In: N Engl J Med. 2003; 349, p. 160.
3. ^ C. Salvarani et al.: Polymyalgia rheumatica and giant cell arteritis. In: N Engl J Med. 2002; 347, p. 261.
4. ^ JC Jennette, RJ Falk: Small-Vessel Vasculitis. In: N Engl J Med. 1997; 337, p. 1512.
5. ↑ PA Bacon: The Spectrum of Wegener's Granulomatosis and Disease Relapse. In: N Engl J Med. 2005; 352, p. 330.

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