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Arteritis
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==Diagnosis== Diagnosis of arteritis is based on unusual medical symptoms.<ref name="Wen 462β473">{{cite journal|last=Wen|first=Dan|author2=Du, Xin|author3= Ma, Chang-Sheng|title=Takayasu Arteritis: Diagnosis, Treatment and Prognosis|journal=International Reviews of Immunology|date=1 December 2012|volume=31|issue=6|pages=462β473|doi=10.3109/08830185.2012.740105|pmid=23215768|s2cid=5434700}}</ref> Similar symptoms may be caused by a number of other conditions, such as Ehlers-Danlos syndrome and Marfan syndrome (both heritable disorders of connective tissue), tuberculosis, syphilis, spondyloarthropathies, Cogans' syndrome, Buerger's, Behcet's, and Kawasaki disease.<ref name="Wen 462β473"/> Various imaging techniques may be used to diagnose and monitor disease progression. Imaging modalities may include direct angiography, magnetic resonance angiography, and ultrasonography.<ref name="Wen 462β473"/> Angiography is commonly used in the diagnosis of Takayasu arteritis,<ref name="Wen 462β473"/> especially in the advanced stages of the disease, when arterial stenosis, occlusion, and aneurysms may be observed.<ref name="Wen 462β473"/> However, angiography is a relatively invasive investigation, exposing patients to large doses of radiation,<ref name="Wen 462β473"/> so is not recommended for routine, long-term monitoring of disease progression in patients with Takayasu arteritis.<ref name="Wen 462β473"/> Computed tomography angiography can determine the size of the aorta and its surrounding branches, and can identify vessel wall lesions in middle to late stages of arteritis.<ref name="Wen 462β473"/> CTA can also show the blood flow within the blood vessels.<ref name="Wen 462β473"/> Like angiography, CTA exposes patients to high dosages of radiation.<ref name="Wen 462β473"/> Magnetic resonance angiography is used to diagnose Takayasu arteritis in the early stages, showing changes such as the thickening of the vessel wall.<ref name="Wen 462β473"/> Even small changes may be measured, making MRA a useful tool for monitoring disease progression without exposing patients to the radiation of direct angiography or CTA.<ref name="Wen 462β473"/> MRA is an expensive investigation, and shows calcification of the aorta and distal branches less clearly than other imaging methods.<ref name="Wen 462β473"/> Ultrasonography is an ideal method of diagnosing patients in early stages of arteritis when inflammation in the vessel walls occurs.<ref name="Wen 462β473"/> It can also show the blood flow within the blood vessels.<ref name="Wen 462β473"/> Ultrasonography is a popular first-line investigation for diagnosis because it is relatively quick, cheap, noninvasive, and does not expose patients to radiation.<ref name="Wen 462β473"/> It is also used for long-term monitoring of disease progression in Takayasu arteritis. Not all vascular lesions are visible on ultrasound, and the accuracy of the scan depends, to some extent, on the person reading the scan, as the results are observed in real time.<ref name="Wen 462β473"/> ===Types=== Arteritis may be primary or secondary to some other disease process. The primary types are: {| class="wikitable" |- !colspan=3| Comparison of major types of arteritis |- ! Arteritis !! Affected organs !! Histopathology |- | [[Takayasu arteritis]] || Large vessels,<ref name="pmid7909656">{{cite journal | vauthors = Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS | title = Takayasu arteritis | journal = Ann. Intern. Med. | volume = 120 | issue = 11 | pages = 919β29 | date = June 1994 | pmid = 7909656 | doi = 10.7326/0003-4819-120-11-199406010-00004 | s2cid = 21784938 }}</ref> including aorta and [[Aortic arch|arch]] branches<ref name=Fleshandbones>Stevens & Lowe: Pathology. At Fleshandbones.com</ref> || Histiocytes, giant cells<ref name=Fleshandbones/> |- | [[Giant cell arteritis]], also often called temporal arteritis (although they differ slightly) || [[Superficial temporal artery]], other medium- and large-sized vessels,<ref name=emedicine>[http://emedicine.medscape.com/article/809492-overview eMedicine Specialties > Temporal Arteritis] Author: Christopher H Lee, MD. Coauthor(s): Jean Marie Hammel, MD. Updated: Sep 8, 2009</ref> e.g. those supplying the head, eyes and [[optic nerve]]s || Lymphocytes, macrophages, and multinucleated [[giant cell]]s<ref name=emedicine/> |- | [[Polyarteritis nodosa]] ||Medium-sized vessels, [[central nervous system|CNS]], [[Peripheral neuropathy|PNS damage]], kidneys, [[gastrointestinal tract]], [[skeletal muscle]], heart<ref name=Fleshandbones/> || [[Neutrophil]]s, [[fibrinoid necrosis]]<ref name=Fleshandbones/> |} An example of a secondary arteritis is arteritis caused by infection with the fungal pathogen ''[[Candida albicans]]''.<ref>{{cite journal|last1=Nagi-Miura|first1=N|last2=Harada|first2=T|last3=Shinohara|first3=H|last4=Kurihara|first4=K|last5=Adachi|first5=Y|last6=Ishida-Okawara|first6=A|last7=Oharaseki|first7=T|last8=Takahashi|first8=K|last9=Naoe|first9=S|last10=Suzuki|first10=K|last11=Ohno|first11=N|title=Lethal and severe coronary arteritis in DBA/2 mice induced by fungal pathogen, CAWS, ''Candida albicans'' water-soluble fraction|journal=Atherosclerosis|date=June 2006|volume=186|issue=2|pages=310β320|doi=10.1016/j.atherosclerosis.2005.08.014|pmid=16157343|display-authors=3}}</ref> ====Giant cell arteritis==== {{main|Giant cell arteritis}} Giant cell arteritis contains two different types of arteritides that are almost indistinguishable from one another.<ref name="Hollier 1β8"/> It includes two types, temporal arteritis and Takayasu arteritis. Both types contain an occupancy of medium- and larger-sized arteries which are categorized based on the infiltration of the giant cells.<ref name="Hollier 1β8"/> ====Takayasu arteritis==== This type of arteritis is most common in females, with a median age of 25 years.<ref name="pmid7909656"/> Takayasu arteritis is more common in women of Asian descent who are in their reproductive years.<ref name="pmid7909656"/> However, over the past decades, its incidence in Africa, Europe, and North America has been increasing.<ref name="pmid7909656"/> Takayasu arteritis is an inflammatory disease that mainly affects the larger vessels such as the aorta and its surrounding branches.<ref name="pmid7909656"/> Research focused on Takayasu arteritis in the western parts of the world remains limited. An estimation suggests that, each year, the number of cases per million people is 2.6.<ref name="pmid7909656"/> ====Temporal arteritis==== Temporal arteritis, the second type of giant cell arteritis, is also a chronic, inflammatory disease involving mid- to large-sized arteries.<ref name="Chen 333β335">{{cite journal|last=Chen|first=Chun-Hsiung|author2=Kung, Shih-Ya|author3= Tsai, Ying-Yang|author4= Liao, Hsien-Tzung|author5= Chou, Chung-Tei|author6= Huang, De-Feng|title=Temporal Arteritis|journal=Journal of the Chinese Medical Association|volume=68|issue=7|pages=333β335|doi=10.1016/S1726-4901(09)70170-4|pmid=16038374|year=2005|doi-access=}}</ref> Temporal arteritis has a higher incidence in people of Scandinavian descent.<ref name="Chen 333β335"/> However, the incidence rate differs based on population, region and races.<ref name="Chen 333β335"/> Temporal arteritis is not uncommon in North America.<ref name="Chen 333β335"/> The incidence rate is around 0.017% for individuals over 50 years of age.<ref name="Chen 333β335"/> Symptoms of temporal arteritis are classified as specific and nonspecific.<ref name="Chen 333β335"/> Nonspecific symptoms:<ref name="Chen 333β335"/> * Headache * Low grade fever * Sweating * Anorexia (loss of appetite) * Weight loss * General malaise Specific symptoms:<ref name="Chen 333β335"/> * Claudication of the jaw * Engorged, tender vessels Specific symptoms usually develop in the advanced stages of temporal arteritis.<ref name="Chen 333β335"/> These symptoms can include damage to eyesight and sudden blindness in one or both eyes.<ref>{{Cite journal |last=Feilchenfeld |first=Zac |date=Nov 2011 |title=Answer: Can you identify this condition? |journal=[[Canadian Family Physician]] |volume=57 |issue=11 |pages=1296β1297|pmc=3215611 }}</ref> Polyarteritis nodosa of unknown mechanism can cause testicular pain. It is often associated with aneurysms and Hepatitis B.
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