Among the numerous autoimmune pathologies Takayasu syndrome highlights its early beginning and erased, rarity timely diagnosis and therefore late onset of adequate treatment, which often leads to disability of patients.
etiology of systemic vasculitis is not fully understood, but clearly traced its connection with infectious and allergic factors and autoimmune aggression.At present, the most likely find a genetic predisposition to the emergence of the disease Takayasu, as evidenced by a number of studies.Patients with this syndrome often detected HLA-DR4 gene, as well as lymphocyte antigen-CF 3.
The disease begins with the development of inflammation in the wall of the aorta and its major branches.As the progression of th
The clinical course is divided into four types of Takayasu's disease.They are characterized by lesions of the different levels of the aorta and its branches, which ultimately determines the symptoms.There are four forms of the disease Takayasu:
1. Type I- artery extending from the aortic arch;
2. Type II- aortic arch and extending from her arteries;
3. Type III- abdominal aorta and renal arteries;
4. Type IV- common lesion of the aorta.
During Takayasu's disease was isolated acute and chronic phase.Symptoms are non-specific acute phase, they are characteristic of many acute infectious disease that is the cause of a rare correct diagnosis at this stage.
For the acute phase is characterized by:
Some of the early symptoms of the disease Takayasu similar to the symptoms of rheumatoid arthritis (arthralgia, skin nodules, pericarditis, pleural effusion).That put this diagnosis the majority of patients at the time of manifestirovaniya disease.
second, chronic stage of the disease develops over a fairly long period of time, an average of 6-8 years.It is characterized by symptoms of narrowing of the affected aorta and its major branches: the manifestations of circulatory failure, lack of pulse in the radial artery (in their involvement in the process), painful lesions of arteries.In the case of arterial stenosis (narrowing of their almost complete clearance) tissue blood flow which was obtained in this way undergo necrosis.With improper blood flow on the radial artery is connected to a characteristic symptom of Takayasu's disease - the lack of a pulse on the wrists.Early symptoms of deficiency of blood supply are numbness, weakness and fatigue in his hands, headaches, tinnitus.At the stage of acute inflammation of the walls of blood vessels, most patients report severe pain in the course of the vessel.
Treatment of patients suffering from Takayasu's disease has two main objectives: to slow down progression of the disease and improve quality of life of patients.To achieve the first goal of using hormone prednisone, which is assigned in high doses for a long time.Cancellation of this drug is only possible when stable remission and there are no signs of progression of Takayasu's disease.
American doctors suggest for best effect combine treatment with prednisolone to the appointment of the drug methotrexate, which is an antimetabolite.According to several clinical studies it can significantly reduce the dose of prednisolone and has proved popular with resistance to prednisolone therapy.
To reduce the risk of cardiovascular complications and prevention of atherosclerosis in patients with Takayasu's disease is recommended to prescribe antiplatelet therapy with aspirin and statins to reduce the amount of atherosclerotic complications.
particularly complex issue is the treatment of hypertension in patients with Takayasu's disease.Blood pressure greater than 160/90 mm Hgregarded as hypertension and treated.Considerable difficulties arise with the pressure measurement in patients with diseased arteries of the upper extremities.In such cases, the blood pressure measurement is made on the feet.But in cases where the patient has a significant narrowing of the arteries, the pressure drop necessitates a drastic deterioration of blood flow and increased ischemia.Therefore, the question of antihypertensive therapy is decided in each case individually.In cases where the cause of persistent high blood pressure is narrowing of the renal arteries, the best tactic is considered surgical removal of the stenosis.
Takayasu's disease in each patient flows in different ways and provokes various complications.Therefore, the question of the treatment of this disease is solved individually in each case, after the complete clinical and laboratory examination in a hospital.
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