Horton's disease: causes, symptoms, diagnosis and treatment
One of the most frequent and dangerous diseases of the blood vessels is Horton's disease. What it is dangerous and how to be treated will be told here.
Nature of the disease
Horton's disease is also known by such names as giant cell temporal arteritis or vasculitis. This disease belongs to the category of autoimmune and is inflammatory in nature. Like other systemic vasculitis, it usually affects the veins, arteries and other large blood vessels. Very often this disease is localized within the carotid shell.
This syndrome is named after the physician of Horton. The disease was discovered in America, in the thirties of the twentieth century. Statistics show that temporal arteritis is most common in northern Europe and the Scandinavian countries. As a rule, the disease affects people of retirement age, and women are sick almost twice as many as men.
It is believed that Horton's disease is caused by a drop in the level of human immunity. Numerous blood tests show that antibodies accumulate in the place of artery vasculitis. Moreover, the development of this disease can depend on the presence of vagus viruses in the body, such as herpes, hepatitis, causative agents of colds. In addition to all of the above, scientists also have a theory about a possible genetic predisposition, as this indicates the presence of the same genes in the patients.
Horton's disease, the symptoms of which are of the most varied nature, can show signs from a few weeks to several months. Sometimes the development of the disease is accelerated after a viral, infectious or catarrhal disease. Symptoms of the disease can be divided into general, manifestations of vascular disease and a drop in the level of vision. As a rule, the presence of at least one of them determines which doctor to apply to.
The manifestation of Horton's disease is an increase in body temperature, frequent and severe headaches, rapid weight loss, rapid fatigue, sleep disorders, joint and muscle pain. As for pain in the head, it can occur both in one part of the skull and in several at once and, as a rule, has a pulsating character. Most often, pains occur at night and become more intense with time. In addition to migraine, patients may be bothered by numbness of the scalp, pain in talking or eating, and unpleasant sensations in the face. The pains in the muscles and joints are localized, as a rule, in the area of the shoulders or thighs. The nature of pain in the joints has a similar nature with arthritis.
Vessels in Horton's disease undergo compaction. Usually they look like nodules, painful and hot to the touch. In these vessels, there are no signs of a pulse or movement of blood. On the scalp is also possible the presence of seals and swelling. Moreover, very often the areas of skin nearby to the arteries change color to reddish-burgundy. There may be edema in Horton's syndrome.
The disease that occurs in the region of the internal carotid artery is particularly dangerous. This is due to the fact that the detection of external symptoms can be difficult. Complications of this course of the disease are also related to the fact that severe damage to a large vessel, not detected in time, can lead to serious negative consequences, such as stroke and hemorrhages.
Falling of vision
Another body that suffers most from the development of Horton's disease is the eyes. The manifestation of vascular disease is very often associated with increased pressure, pain, bifurcation and other abnormalities in vision. This is due primarily to the lack of proper blood circulation in this place. With timely treatment begun, serious consequences can be avoided, otherwise the patient is at risk of complete optic nerve atrophy and subsequent blindness.
This disease is detected mainly through an external clinical examination, as well as research results analysis. In evaluating the patient's condition, special attention is paid to neurological health. It should be taken into account that this disease can strongly influence the level of vision, therefore, its verification has an important role. As a laboratory study, a biopsy from a damaged vessel is taken, and ultrasound dopplerography, magnetic resonance imaging or computed tomography of the brain is administered to the patient.
Results of the
research On the data obtained during the diagnosis, it is possible to judge the stage of the disease and decide on the treatment. As a rule, the results are complex information obtained after the examination and laboratory studies.
As a result of blood sampling, presence of insufficiency of blood cells, increase of leukocyte count and acceleration of erythrocyte sedimentation are established. In a complete analysis, a change in the ratio of protein fractions of blood and a decrease in the level of albumins is usually detected from the vein.
In the study of vision, doctors pay special attention to the establishment of its acuity and the presence of defects and destruction of the inner bottom of the eye.
Biopsy and studies of the cellular material of the damaged vessel make it possible to establish benign changes in the thickness and structure of the vessel in Horton's syndrome. The disease usually occurs in the form of granular nodules in the artery walls. Such a development can not but affect the functionality of the vessel itself: in due course its lumen becomes narrower and narrower.
However, there are cases when such changes in the artery or vein are not observed. This can be explained by the fact that the damage to the vessel is very pointlike and not always susceptible to establishment. This is due to the fact that the lesion of the artery is segmental and during the biopsy it is possible to take the uninfected part of the artery.
In addition, all described symptoms depend only on the characteristics of the organism of each individual patient, including on his age, lifestyle and other factors. Thus, the Association of American Rheumatologists cites statistics, which indicate that the course of the disease is greatly influenced by a wide variety of demographic factors. They include the age of the patient, especially if he is over 50 years old.
Problems in diagnosing
When establishing the symptoms of Horton's disease, it should also be distinguished from similar diseases, such as arthritis, rheumatism, neuralgia, pathology of the lymphatic system, systemic vasculitis. This is especially true of people of advanced age. The course may differ from that in other age groups, since very often changes in veins and arteries associated with other diagnoses fit the description of Horton's syndrome. The disease is confused, for example, with atherosclerosis. However, headaches in this case are of a completely different nature. In addition, vasculitis is characterized by a much more intense level of erythrocyte sedimentation and more vivid changes in the walls of the vessels, which are manifested during biopsy. Sometimes such mixed symptoms can cause the patient's problem in the question of which doctor to apply to.
This disease is eliminated by the use of glucocorticoids. As a rule, at the beginning of treatment the doctor attributes the therapy to these drugs, which lasts for two years. The course is terminated if the patient has complete relief from the disease and there is no relapse. The use of corticosteroids has a positive effect on Horton's disease.
Treatment with hormonal drugs is carried out according to the appropriate scheme, taking into account the nuances of the course of the disease. With slow development, the patient is prescribed to take pills containing prednisolone in the calculation from 20 to 80 milligrams per day. With intensive development of the disease, it is more expedient to apply shock therapy with large doses of methylprednisolone. After a month of copious treatment, dosage reduction is possible. In this case, every week the dose of the drug is reduced to a maintenance level, which is about 5-7.5 milligrams per day. After two years of treatment, there may be a question about the abolition of therapy due to the absence of relapses. For the last six months, the patient may be on a maintenance dose of 2-2.5 milligrams of hormone drug per day.
However, it is possible that the treatment with glucocorticoids does not give the expected effect. In this case, it is advisable to administer cytostatics. Moreover, in addition to hormone therapy, anticoagulant preparations and antihistamines can be prescribed.
disease It should be noted that such a disease is not a threat to the life of the patient as a rule. Some rare, neglected cases of the disease can lead to impaired vision, including blindness, as well as to the development of stroke, heart attack and necrosis. However, the disease can be treated in the vast majority of cases. Forecasts with properly selected therapy are mostly favorable. In the absence of relapses in the next two years of life, the patient is told that, most likely, they will not take place in his later life. Rare complications during treatment can be associated exclusively with personal intolerance to patients with corticoid therapy. Do not forget the main rule of successful treatment - a diagnosis should be made only by a doctor! He also has the exclusive right to prescribe treatment.
As one of the factors of the disease occurrence is its viral nature, it is very important to adhere to a healthy lifestyle and conduct hardening of the body. It should also be remembered that the likelihood of developing vasculitis is genetically determined, and not subject to excessive risk.
Patients are also often interested in the question: are disabilities given in Horton's disease? As a rule, severe inconveniences in the disease can lead to its extradition, because the complex course of the disease, which manifests itself in severe headaches and tear, does not allow the employee to perform his duties for a long time, in bright light, including.