LINE POLYAPTERIATE

LUNG POLYARTERITIS (syn: nodular periarteritis) -Systematic lesions of arteries predominantly of medium and small caliber. The disease often develops after the introduction of serum vaccines, antibiotics, sulfonamides and some other medications that the patient does not tolerate. At the heart of the disease is the immunocomplex lesion of the vascular wall, leading to a violation of microcirculation in the organs and tissues.

Clinical picture . The most frequent signs are fever , which can not be cured with antibiotics, progressive weight loss, severe weakness. There may be pain behind the sternum or in the area of ​​the heart resembling angina. Arterial hypertension is typical . The defeat of the lungs is manifested by coughing, shortness of breath, hemoptysis, attacks of suffocation that resemble bronchial asthma and can precede the development of other symptoms of the disease.

When involved in the process of the abdominal cavity organs, abdominal pain (sometimes a picture of the acute abdomen), stool and gas retention, and gastrointestinal bleeding can be observed. The defeat of the kidneys is usually manifested by proteinuria, hematuria with gradual development of renal insufficiency. Possible heart attacks of the kidneys. There is a development of polyneuritis, characterized by the gradual emergence and asymmetry of the lesion. A typical symptom of the disease is the detection of subcutaneous tight knots, often painful, which are inflammatory infiltrates or aneurysms of blood vessels. In the blood neutrophilic leukocytosis , eosinophilia, an increase in ESR, a small normochromic anemia.

In most cases, nodular polyarteritis proceeds chronically with alternating exacerbations and remissions. The acute onset of the process, under the influence of treatment, sometimes acquires a chronically recurring course.

The diagnosis of nodular polyarteritis should be suspected in patients with fever, weight loss, kidney damage with hypertension in combination with other symptoms (asthma attacks, polyneuritis, leukocytosis).

Treatment . Prescribe prednisolone in a daily dose of 30-40 mg, followed by a decrease to maintenance doses (10-15 mg / day). In the absence of effect, a combination of prednisolone and cytostatics (azathioprine, cyclophosphamide) is shown. In addition, apply heparin , trental, quarantil. In some cases, hemosorption or plasmapheresis is indicated.

The forecast as a whole remains unfavorable. Modern therapy can provide stabilization of the process. Almost half of the patients manage to achieve remission.