temporal arteritis
Introduction
Introduction to temporal arteritis Temporal arteritis, also known as cranial arteritis, is named after the anatomy. It is a kind of inflammation of the large and middle arteries, which can involve arteries in multiple sites, but all have radial artery damage. Clinically, it is characterized by headache, fever, eye pain, generalized pain and progressive visual impairment or even blindness. This disease is closely related to rheumatic polymyalgia. basic knowledge The proportion of illness: 0.001% Susceptible population: The age of onset is most common in people over 50 years old, and the ratio of male to female is 1:3. Mode of infection: non-infectious Complications: myasthenia gravis chronic ulcerative colitis
Cause
Cause of iliac arteritis
Cause (20%):
The cause is still unclear. It is currently believed that bacterial and viral infections have a certain relationship with the disease, but no exact evidence has been found. Smoking and sun exposure can cause or aggravate the disease.
Pathogenesis (10%) :
The autoimmune reaction is involved in the onset of the disease. Immunofluorescence is used to observe the deposition of immunoglobulin in the vascular wall. This immunoglobulin is an anti-vascular wall component such as elastin antibody, and also has the presence of immune complexes and complement, indicating the disease. The autoantibody or autoantigen antibody complex activates the classical pathway of complement and causes a series of inflammatory reactions. There is also a large amount of evidence that T cell-mediated cytotoxicity plays an important role in the pathogenesis of this disease. The cells can transform the skeletal muscle and arterial antigen, accompanied by the release of lymphokine, indicating that the immune response mediated by the cell immune system also plays an important role in the pathogenesis of the disease. In addition, it is found that the familial incidence of the disease is obvious, HLA -DR4, HLA-138 expression enhancement may be the susceptibility gene of this disease, and other vasculitis such as polyarteritis, classic nodular polyarteritis, thromboangiitis obliterans, and this disease have been found. Coexistence, which fully demonstrates that the immune mechanism is directly related to the pathogenesis of the disease, it is reported that the disease can still be associated with hypertension, arteriosclerosis , Diabetes and liver disease exist, which means that humoral factors may be involved in metabolic abnormalities are causative of the disease.
Prevention
Arteritis prevention
There are no good preventive measures for vascular inflammatory neurological damage. Early diagnosis and early treatment should be used. In the remission period, the hormone maintenance dose should be taken for several months, which can improve the prognosis and treat and control the secondary nervous system damage. It is the main measure for prevention. .
Complication
Arteritis complication Complications Myasthenia gravis Chronic ulcerative colitis
Overlapping organ-specific autoimmune diseases such as thyroiditis and hyperthyroidism can occur unilaterally or bilaterally, with sudden blindness caused by ischemic optic neuritis, the most serious complication of this disease.
The pathological damage and dysfunction of tissues and organs is limited to an organ to which an antibody or sensitized lymphocyte is directed. Mainly have chronic lymphatic thyroiditis, hyperthyroidism, insulin-dependent diabetes mellitus, myasthenia gravis, chronic ulcerative colitis, pernicious anemia with chronic atrophic gastritis, pulmonary hemorrhagic nephritis syndrome, pemphigus vulgaris, pemphigus , primary biliary cirrhosis, multiple cerebrospinal sclerosing, acute idiopathic polyneuritis.
Symptom
Symptoms of iliac arteritis Common symptoms Joint pain, deafness, fatigue, visual impairment, facial pain, hyperhidrosis, double vision, superficial temporal artery
Temporal arteritis is a common disease with a prevalence of about 24/100,000. This disease is a senile disease. The age of onset is most common in people over 50 years old. The ratio of male to female is 1:3. Onset and seasonal changes. There is a clear relationship between the upper respiratory tract infections that occur.
In addition to the involvement of the radial artery, the disease is often systemic or systemic, multiple, arteritis, such as carotid artery, aorta, subclavian artery, coronary artery, mesenteric artery, radial artery, femoral artery, radial artery and Various branches of the carotid artery, such as the facial artery, the occipital artery and the ophthalmic artery, can be involved.
Early symptoms are mild, recessive onset, systemic symptoms include fever, discomfort, fatigue, weakness, sweating, anemia, headache and joint pain, accompanied by rheumatoid polymyalgia (polymyalgia rheumatica), manifested as double Lateral symmetry muscle stiffness, pain, neck, shoulders, lower back, hips, thighs, etc. Pain, activity is obvious, some patients with rheumatic polymyalgia as the first symptom, myalgia can cause muscle weakness, But not the main performance, weight loss can be similar to malignant wasting disease, polymyositis or hyperthyroidism, musculoskeletal symptoms can be located in the shoulder joint tendon or tendon attachment, similar to shoulder joint tendonitis or bursitis, also Similar to cervical arthritis.
The most commonly affected joints are sterno-lock joints, shoulder joints, knee joints, spine and pelvic joints. Occasionally, peripheral joint pain can be severe to rheumatoid arthritis. Pain can occur after several weeks or months of systemic symptoms. Arteritis, clinically, often regards arteritis and rheumatic polymyalgia as different manifestations of a disease process. In addition, many patients present with typical multiple rheumatic myalgia without radial artery. Symptoms of inflammation, only when the radial artery biopsy is found to have temporal arteritis, when the arteritis and rheumatic polymyalgia are accompanied, usually the first symptom of myalgia, followed by the brachial artery within a few months Inflammation, this disease often overlaps with organ-specific autoimmune diseases such as thyroiditis and hyperthyroidism.
When iliac arteritis occurs, the affected blood vessels are segmental local swelling, which can last for several days, and there is local pain. In this period, angiographic angiographic stenosis with different lengths can be seen, and the stenosis and normal parts appear. Large blood vessels affected parts can hear vascular murmurs during auscultation. The most common symptoms of temporal arteritis are unbearable pain. Sometimes they can't comb their hair and stay in bed. The headache can be bilateral or unilateral. May be associated with scalp pain, paresthesia, numbness or burning sensation, increased wind blowing, headache caused by occipital arteritis is mostly located in the back of the head, at this time can not supine, upper iliac arteritis can cause toothache and oral pain during chewing Tongual arteritis can cause numbness of the tongue, abnormal taste, recurrent paleness, eye pain can be the first symptom of the disease, which means that the posterior tibial artery has been affected, unilateral or bilateral onset, ischemic optic nerve Sudden blindness caused by inflammation, the most serious complication of the disease, sparks in front of the eyes or flashing in front of the eyes, is a prodromal symptom of blindness, in addition, blurred vision, quadrant vision Defects, sometimes visual symptoms can also change with changes in body position, which may be due to changes in blood flow through the diseased blood vessels when carotid arteries change, ischemic retrobulbar optic neuritis or central retinal artery occlusion It can also cause vision loss. The fundus shows pale disc, edema, streaky hemorrhage at the edge of the nipple, and the arteries become thinner. After a few days, the retina can have hemorrhage and flocculation exudative spots. After exudation, it is absorbed for 4 months. Neurotrophy can occur afterwards, and this change is the most common terminal consequence of the disease.
Various visual field defects can occur, and small branching of the ciliary artery can cause partial defect of the visual field. The anterior pituitary arteritis and the small arteries of the blood supply optic chiasm often cause bilateral sacral visual field defects. The vertebral artery embolization can cause bilateral occipital lobe Sexual blindness (cortical blindness).
Eye movement disorder is also a common symptom of the eye. It is common for eyelid ptosis, followed by diplopia, which occurs mostly in the early stage of eye involvement. It is a prodromal symptom of blindness and lasts for several weeks. This is due to the 3rd, 4th, and 6th. Caused by incomplete blood supply to the brain.
Sometimes it can be manifested as deafness or ear pain, which is caused by damage to the blood vessels of the blood supply to the cochlea.
Examine
Examination of temporal arteritis
1. Blood routine and blood sedimentation
All patients with active erythrocyte sedimentation rate increased, most patients have anemia, sometimes red blood cells are arranged in a string of money, white blood cells can be slightly elevated, platelets can increase, and occasionally eosinophils.
2. Urine routine
Individual patients may have mild proteinuria and hematuria with few casts.
3. Biochemical inspection
There may be abnormal liver function and elevated alkaline phosphatase. These two changes are especially common in patients with rheumatoid polymyalgia. There may be elevated transaminase. Protein electrophoresis shows 2, gamma globulin and pseudohemophilia. Factor (vWF) and complement elevation.
4. Immunological examination
Most patients have elevated IgG, IgM, and IgA, and a few may have rheumatoid factor positive, but the titer is low, and a few patients have ANCA positive.
5. X-ray inspection
Angiography can reveal segmental stenosis or occlusion of the branches of the internal and external arteries and related branches of the aorta.
6. Other
Some patients may have EEG abnormalities.
7. In histopathology, the disease is a full-thickness arteritis, the most important pathological features are:
1 has a specific predilection site;
2 arterial involvement is limited, segmental distribution, forming a jumping phenomenon;
3 There are inflammatory cell invasive vasculitis in the whole layer of diseased blood vessels, especially in the endovascular lesions, which are characterized by lymphocytes, plasma cells, mononuclear macrophage infiltration, and muscular outer membrane degeneration, most of which are destroyed;
4 The formation of giant cells in the elastic layer of the blood vessel wall is glassy-like degeneration, and the elastic fiber collapses. The giant cells contain denatured and sometimes calcified elastic fibers, and the middle layer fibers proliferate, which is also a characteristic pathological change of the disease;
5 lesions intimal hyperplasia, thickening of the wall, stenosis or occlusion of the lumen and thrombosis, visible peripheral tissue ischemia or infarct histological changes associated with damaged vessels, accompanied by circular infiltration of vascular trophoblasts, Lesions can be caused by spotted solitary disease along the artery.
Diagnosis
Diagnosis and diagnosis of iliac arteritis
diagnosis
For patients over 50 years old, when there is fever, anemia, increased erythrocyte sedimentation rate, headache, eye pain or sudden change in vision, with or without myalgia, the disease should be highly suspected, and there are obvious local touches along the radial artery. Pain and blood vessels harden, thicken, can be basically diagnosed as the disease, patients with atypical clinical manifestations, some can be expressed as ocular symptoms in the front, vasospasm symptoms in the after, at this time should be vigilant, for elderly patients Long-term unexplained fever, accompanied by increased erythrocyte sedimentation rate, should be considered as the disease, because early fever is particularly common in this disease, the elderly have any kind of headache or facial pain accompanied by increased ESR, should be considered as Arteritis, radial artery biopsy confirmed typical histopathological changes, can be diagnosed as the disease, in a few cases, the radial artery is not tired, but the involvement of the internal carotid artery and aortic branch, at this time, combined with clinical, ophthalmic examination and X Line angiography found that the disease can be diagnosed.
Differential diagnosis
The disease should be differentiated from cholesterol embolism, sepsis, infective endocarditis, left atrial myxoma and tumor.
