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Vasculitis

heart and arteries

What is vasculitis?
Vasculitis is an inflammatory disease of blood vessels that can affect any number of organs, including the skin. It is believed to be autoimmune in nature and occurs when the immune system attacks the blood vessels, mistakenly perceiving them as threats to health. Any blood vessels can be affected. The inflammation can cause a blood vessel to narrow or close off, limiting or blocking the flow of blood. Like other autoimmune diseases, vasculitis can go into remission for periods of time but can flare up at any time. In some cases, vasculitis is chronic and never goes into remission.

There are quite a few types of vasculitis that differ from each other on the basis of the organs involved, although all types involve inflamed blood vessels. These include:

  • Behçet's disease which causes mouth and genital ulcers, eye inflammation and acne
  • Buerger's disease, which appears to be caused or aggravated by smoking or other uses of tobacco (such as chewing) and causes pain in the hands, arms, legs and feet and ulcers on fingers and toes
  • Churg-Strauss syndrome, which is associated with asthma and usually affects blood vessels in the lungs
  • Cryoglobulinemia, associated with hepatitis C infections, causes a rash on the lower extremities, arthritis, weakness and neuropathy (nerve damage)
  • Giant cell arteritis, which affects arteries in the head and causes headaches, scalp tenderness, jaw pain while chewing, blurred or double vision, and even blindness. Giant cell arteritis is often associated with polymyalgia rheumatica (PMR)
  • Microscopic polyangiitis, which affects small blood vessels in the kidneys, lungs and skin and causes  skin lesions, fever, weight loss, nerve damage and inflammation of small blood vessels in the kidneys
  • Wegener's granulomatosis which causes inflammation of the blood vessels in the nose, sinuses, throat, lungs and kidneys and causes stuffed nose, chronic sinus infections and nosebleeds among other symptoms.

What are the symptoms of vasculitis?
General signs of vasculitis can include fever, weight loss, fatigue, and general aches and pains. More specifically, the inflammation and disrupted blood flow can lead to complications and damage to the affected organs. Here's a rundown of symptoms that can occur in different organs:

  • Skin: Purple or red spots or bumps on the skin, clusters of small dots, splotches, bruises or hives as well as itching
  • Joints: Aching or the development of arthritis in one or more joints
  • Lungs: Shortness of breath, coughing up blood
  • Digestive system: Mouth ulcers, stomach pain; in severe cases where blood flow to the intestines is blocked, weakening or perforation of the intestinal wall
  • Sinuses, nose, throat and ears: Chronic middle ear infections, ulcers in the nose and in some cases, hearing loss 
  • Eyes: Itching and burning, sensitivity to light, blurred vision; in rare cases blindness
  • Brain: Headaches, changes in mental function, stroke-like symptoms including muscle weakness and paralysis
  • Nerves: Numbness, tingling, weakness in some parts of the body, loss of feeling.

What are the causes?
The cause is unknown, but there is probably an autoimmune aspect to the condition. The immune system's attack on blood vessels may be triggered by an infection, medication or another disorder. Vasculitis can occur on its own or as a component of other autoimmune disorders. It can occur in either gender, among people of all ages and races. Beyond that, vasculitis appears to occur most often in people with chronic hepatitis B or C and among smokers. 

How is vasculitis diagnosed?
Several kinds of tests, usually in combination, are used to diagnose vasculitis:

  • Blood tests, some of which can determine whether or not you're anemic, whether certain antibodies are present, and whether you have signs of inappropriate levels of inflammation.
  • Biopsy to look for signs of inflammation or tissue damage
  • Blood pressure measurement, as high blood pressure commonly accompanies vasculitis
  • Urinalysis to look for abnormal levels of protein or the presence of blood cells that can indicate kidney involvement
  • Electrocardiogram (EKG) and/or echocardiography to see if the heart is affected
  • Chest x-ray to see if vasculitis is affecting the lungs or large arteries such as the aorta or pulmonary arteries
  • Lung function tests to see how well the lungs deliver oxygen to the blood
  • Abdominal ultrasound to determine whether vasculitis is affecting the abdominal organs
  • Computed tomography (CT) scan to look for damage to abdominal organs or blood vessels
  • MRI (magnetic resonance imaging) to further assess any damage to internal organs
  • Angiography to see if specific blood vessels are narrowed, swollen, deformed or blocked. 

What is the conventional treatment of vasculitis?
The goal of treatment is to reduce the inflammation induced by the autoimmune process. Conventional medicine treats autoimmune disorders with corticosteroids and other immunosuppressive drugs. While these are useful for short-term management of the worst crises, they are highly toxic when taken long term.

In mild cases, only over-the-counter drugs such as acetaminophen, aspirin, ibuprofen or naproxen may be needed to treat inflammation, but in more severe cases, corticosteroids such as prednisone, prednisolone and methylprednisolone are used. If they don't work well, or if vasculitis is severe, cytotoxic drugs may be prescribed (sometimes in addition to steroids) to destroy the cells causing the inflammation. These include azathioprine, methotrexate and cyclophosphamide.

Beyond that, certain types of vasculitis may require other drugs. For example, Kawasaki disease, a rare childhood disorder in which blood vessel walls throughout the body become inflamed, usually is treated with high-dose aspirin (although a 2004 study by Taiwanese researchers found it had "no appreciable benefit") and immune globulin. In some cases, surgery may be needed to remove an aneurysm (an abnormal bulge in a blood vessel wall) that has developed as a result of vasculitis. 

What therapies does Dr. Weil recommend for vasculitis?
Dr. Weil suggests following his anti-inflammatory diet as well as the measures listed below that can bring about dramatic improvement in patients with autoimmune disorders:

  • Eliminate cow's milk and cow's milk products (substitute other calcium sources)
  • Eat more fruits and vegetables (make sure that they are organically grown)
  • Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, all foods (such as deep-fried foods) that might contain trans-fatty acids. Use extra-virgin olive oil as your main fat
  • Increase your intake of omega-3 fatty acids. Take two to three grams of a molecularly distilled fish oil supplement each day
  • Take anti-inflammatory herbs such as ginger and turmeric. Dr. Weil recommends unsweetened turmeric tea, as well as a combination of ginger, turmeric, and other botanicals with anti-inflammatory properties.
  • Consider taking grape seed extract, a source of powerful antioxidant compounds called OPCs (oligomeric proanthocyanidins). Research has shown these compounds to be useful in protecting blood vessels, making them more elastic and less likely to leak.

Because autoimmune diseases tend to flare up in response to emotional ups and downs, Dr. Weil suggests trying some form of mind/body treatment such as:

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