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Vasculitis Heidelberg

Inflammation of large, medium and small vessels

Vasculitides are inflammations of the blood vessels. The various forms differ mainly in which vessel regions and vessel sizes are affected. Any organ (e.g. kidney, lung, eye, bowel, nerves, skin/mucous membranes) or body region (e.g. ear, nose and throat) can be involved.
The complaints are varied and depend on the organ or region affected (e.g. lungs: coughing up blood; nose: bloody nasal discharge; eye: “red eye”; bowel: bloody diarrhoea; nerves: sensory disturbances; skin/mucous membranes: rashes).

At the outset, general symptoms such as malaise, night sweats, weight loss and fever, or muscle and joint pain, can point to vasculitis. Inflammatory markers are usually raised, and in some cases specific antibodies (ANCA: anti-neutrophil cytoplasmic antibodies) can be found.

Since 2013, some forms of vasculitis have been renamed. The abbreviations and “old” names are given in brackets below where applicable.
Classification is based on the size of the vessels affected.

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Large-vessel vasculitis

It usually occurs after the age of 50. Severe, one-sided headache at the temple is the main symptom, and the temporal artery is often palpably hardened. If the artery supplying the eye is involved, vision can deteriorate suddenly, up to loss of sight. Pain when chewing solid food or muscle pain close to the trunk can also be indicative. The vessels supplying the brain, the vessels of the arms and legs and the aorta can also be affected.

PMR mainly affects older people, and women more often than men. The main symptom is muscle pain, like sore muscles, in the shoulder/neck and pelvic girdle. The pain is worst at rest and at night and is accompanied by restricted movement and reduced strength.

It mostly affects women under 40. The vascular inflammation can narrow large vessels up to occlusion and loss of pulse. Patients typically present with exertion-related pain in the arms and legs (“window-shopper’s disease”). A blood pressure difference between the right and left arm can be a clue.

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Medium- and small-vessel vasculitis

This mainly affects the vessels of the gastrointestinal tract; bulges (aneurysms) and occlusions (stenoses) of the vessels are typical. Characteristic skin changes occur, and nerve involvement is common.

The main symptoms are chronic sinusitis and bloody, crusty nasal discharge. The lungs and kidneys can also be affected.

Most patients report asthma-like complaints. Chest X-rays may show changes resembling pneumonia. The peripheral nerves are often involved, for example as polyneuropathy.

The kidneys and lungs are frequently affected together. Severe cases require intensive care.

Variable-vessel vasculitis

The main symptoms are recurrent, painful small mucosal lesions (“aphthous ulcers”) in the mouth and genital area. Skin changes (e.g. erythema nodosum) and eye involvement are also common. The disease is more frequent in patients from the Mediterranean region and mainly affects young men. Genetic factors appear to play a role; 30–70% of patients carry the HLA-B51 antigen.

Whatever vessel region or vessel size is affected, our rheumatology practice in Heidelberg is here for you. Our empathetic specialists competently take care of the diagnosis and treatment of your rheumatic disease. Please feel free to contact us.

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