Arteritis: The Basics

OVERVIEW OF ARTERITIS

Arteriti is an inflammation of the arteries with a resultant damaging of the walls of the arteries and subsequent decrease in blood flow to the body. Various kinds of arteritis exist. The clinical features seen in arteritis depend on the artery involved and the extent of the damage.

Arteritis
Photo Credit: Mayo Clinic

TYPES OF ARTERITIS

The various kinds of arteritis that exist include:

  • Takayasu’s  arteritis
  • Giant cell arteritis (GCA)
  • Polyarteritis Nodosa (PN)

TAKAYASU’S ARTERITIS

This is also known as aortic arch syndrome or non-specific aorto-arteritis. It commonly affects young and middleaged females that are Asian in origin. The walls of the aorta get inflamed alongside the upper branches of the aorta. This leads to fibrosis or scarring.

As time goes by, the aortic wall gradually thickens and the upper and lower branches of the aorta narrow slowly thus causing a decrease in the blood, oxygen, and nutrient supply to other body parts. The upper body may be rendered pulseless or just a faint pulse will be felt if the main branches of the aorta are damaged.

Takayasu’s arteritis can cause the following:

  • Visual impairment
  • Heart disease
  • High blood pressure
  • Fainting
  • Joint pains
  • Muscle ache
  • Fatigue
  • Malaise
  • Fever
  • Night sweat
  • Weight loss

As the walls of the artery keep getting weak, aortic aneurysm results, it is just a ballooning of the aorta. If this aneurysm ruptures, it can be fatal. Takayasu’s arteritis is not treatable but the condition can be managed with immunosuppressive drugs.

GIANT CELL ARTERITIS (GCA)

Giant cell arteritis known as temporal arteritis is an inflammation of the superficial temporal artery and other arteries that supply blood to the head, eyes, and jaw. This inflammation is caused by infection. GCA is commonly seen in women that are above the age of 50 and in women of Northern Europe descent.

GCA usually begins with symptoms resembling flu. These symptoms include:

  • Serious headache
  • Fever
  • Body aches
  • Pains
  • Appetite loss
  • Weakness and tiredness

The arteries that are involved will be swollen and may be tender on touch especially when the involved arteries are those at the side of the head. As the inflammation worsens, blood circulation to the optic nerve, facial nerve and to the jaw becomes interrupted. This leads to visual loss, jaw ache, scalp pain, and many other symptoms.

Visual loss is the major problem with GCA, it happens when the arteries of the eyes get blocked. GCA rarely results in death. To prevent permanent damage, immediate administration of corticosteroids may be beneficial.

POLYARTERITIS NODOSA (PN)

This is also known as Kussmaul disease, Kussmaul-Maier disease, or infantile polyarteritis nodosa. It occurs when the small and medium arteries that supply the body with blood from the heart get inflamed. The symptoms that occur depend on the blood vessel affected. Most times, the cause of PN is not known. It mostly occurs in men that are within the age of 30 to 49. It can also occur in people with chronic hepatitis B but this is in rare cases.

The symptoms and effect vary because very many blood vessels can be affected.  PN, like other kinds of arteritis, starts with flu-like symptoms which include:

Bruising may also occur on the skin with rashes and sores occurring.

When the central nervous system gets affected, one may experience any or a combination of the following symptoms:

  • Pain
  • Burning sensation
  • Numbness
  • Weakness

When the kidneys get affected, renal failure may result, high blood pressure and edema too. The heart can also be affected and it may be in the form of a heart attack or heart failure. Pericarditis, which is an inflammation of the sac around that encircles the heart can occur especially when the arteries that supply the heart are affected.

PN can be managed by using immunosuppressive drugs though you will stand a greater chance of relapsing in the future. When left untreated, the disease is fatal.

CAUSES OF ARTERITIS

The exact cause of arteritis is not known, it is thought to be an autoimmune disease. The cells of the immune system attack the blood vessel walls to cause different grades of damage. The immune cells that are present in the blood vessels form nodular structures called granulomas which occlude blood flow to other body parts. The inner cells of the blood vessels may become weak and more susceptible to developing aneurysms. Aneurysms when ruptured, result in internal bleeding.

Arteritis can cause blood loss and deficient oxygen supply to the internal organs. When blood flow is impaired, blindness, heart failure, and kidney failure can result depending on the artery that has been affected. Early diagnosis and treatment is essential to prevent organ damage caused by arteritis.

DIAGNOSIS OF ARTERITIS

The diagnosis of arteritis is carried out by doing the following;

  • Taking a medical history
  • Performing a physical examination
  • Carrying out laboratory tests
  • Imaging tests
  • Biopsy of the blood vessel involved

HISTORY TAKING

The doctor takes a concise medical history with special reference to the following:

  • Age
  • Race
  • Gender
  • The pattern of the symptoms in the early and later stages

A general physical examination is done for the affected body parts.

LABORATORY TESTS

The relevant laboratory tests that are done include:

  • An erythrocyte sedimentation rate which detects inflammation
  • C-reactive protein test to also detect inflammation
  • Full blood count to check for infection and anemia
  • Liver function test to check for alkaline phosphatase which is mostly increased  in people with arteritis

IMAGING

The usual imaging tests that are ordered include:

These tests help to show the condition of the arteries, the severity of blockage and the presence or absence of aneurysms.

BIOPSY

A biopsy is indicated if the condition of the cell wall is to be checked. It is performed by a doctor.

TREATMENT OF ARTERITIS

The primary treatment is to suppress the immune system. This is achieved by the administration of immunosuppressive drugs such as corticosteroids (prednisolone), or other drugs that serve the same function.

Secondary infections can be treated with the use of antibiotics. Surgery may be indicated for those with damaged organs to revive or replace them.

LONG TERM OUTCOME

Majority of people who suffer from this condition will recover. The treatment may take a long time and if the disease was severe enough to cause organ damage, it will alter the treatment requirements and even the outcome. Talk to your doctor to be more informed on your condition and the long term effect.

If you have a past history of arteritis, you stand a higher chance of its recurrence so you must be on the watch for its symptoms. Early diagnosis and treatment help reduce organ damage.

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