ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The vasculitides are often considered diseases caused by an immune response to a causative antigen. However, multiple decision points are involved in guiding an inflammatory process toward healing and repair versus destruction and disease. This review focuses on determinants that have the potential to alter decision points but have only recently begun to attract attention. Vasculitic disorders often exhibit a strict age preference. Progress has been made in the understanding of immunosenescence and its implications for immunocompetence as well as for the development of chronic inflammation. A second aspect in the pathogenesis of vasculitis is the distinct tissue tropism, involving preference for vessels of defined sizes and distributions. Studies in giant cell vasculitis have begun to shed light on the interaction between the affected tissue and the inflammatory cells and suggest that the vascular microanatomy determines the organization of the infiltrate. An important role may be attributed to the tunica adventitia, which harbors regulatory cells and probably provides the port of entrance for infiltrating cells. Finally, data are accumulating on the importance of the host's immunoresponsiveness in the decision between a beneficial and a pathologic inflammation. Studies in giant cell arteritis have shown that differences in the immunomodulatory milieu that are partially accomplished through the action of cytokines are responsible for disease heterogeneity and outcome.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Takayasu's arteritis is a chronic vasculitis, the etiology of which is still unknown. This condition involves primarily the aorta, its main branches, and the coronary and pulmonary arteries. One epidemiologic characteristic of this morbid condition is that almost all patients come from Asian and South American countries, which has led to searches in the role of genetic factors in its pathogenesis. International surveys on HLA analysis have focused on HLA-B52 and B39 disequilibrium with this morbid condition. These comparative studies have made clear the different characteristic clinical manifestations among Asian and South American countries, which will prompt further studies in relation to genetic factors in the future.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Activation of the vascular endothelium by several different stimuli plays a crucial role in the initiation, localization, and propagation of vascular injury.In vitrostudies have demonstrated that activation of cultured vascular endothelial cells renders them hyperadhesive for leukocytes. During the past decade it has become evident which cell adhesion molecules play a critical role in the interaction between the vascular endothelium and leukocytes in inflammation in general. Over the past year, advances have been made in understanding the interactions between leukocytes and vascular endothelial cells in vasculitis. Several studies have shown increased expression of adhesion molecules on circulating leukocytes and,in situ, in vasculitic lesions. Soluble adhesion molecules have appeared to be general nonspecific markers of endothelial activation. Hence, the clinical relevance of measuring soluble adhesion molecules is limited. Finally, the possibility of inhibiting adhesion molecule functionin vivoremains an attractive therapeutic option in the vasculitides and is a focus of increasing research activity.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

With the opportunity for long-term follow-up, it has been appreciated that disease severity may vary considerably in patients with Wegener's granulomatosis, polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome. Although combined therapy with cyclophosphamide and glucocorticoids continues to be the foundation of treatment, concerns have increased about the toxicities of this regimen. As illustrated by studies on Wegener's-related subglottic stenosis and endobronchial involvement, it has also become apparent that some disease manifestations may not respond to this therapy. Recent therapeutic investigations have therefore focused on identifying approaches that are less toxic and that are based on anatomic involvement and disease severity. The study of polyarteritis nodosa has additionally been affected by proposed changes in classification that would make this condition a separate entity from microscopic polyangiitis. As progress is made in defining the clinical significance of this nomenclature, the prognostic factors in these patients have also been examined, which may be helpful in guiding therapeutic decisions.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

It is admitted that viral infections can be responsible for systemic vasculitides. Viruses can be responsible for various types of vasculitis that affect vessels of different sizes. Clinical manifestations are the same as those observed in previously described vasculitides such as polyarteritis nodosa or cryo-globulinemia. When viral infection is diagnosed and considered to be responsible for vasculitis, a specific therapeutic approach must be prescribed. Treatment is based on the combination of antiviral agents and symptomatic or immunomodulating therapies. Antiviral therapy facilitates virus clearance and seroconversion to specific antibodies. In systemic vasculitides, plasma exchanges are a powerful treatment that clears circulating immune complexes. In the case of digital ischemia, vasodilators are also useful. Conversely, steroids and cytotoxic agents stimulate virus replication and favor disease chronicity and deleterious effects due to the presence of the virus. Hepatitis B virus-related polyarteritis nodosa can be cured with the combination of antiviral agents (mainly interferon alpha) and plasma exchanges. Hepatitis C virus-related cryoglobulinemia responds to interferon alpha and sometimes to plasma exchanges, but responses are usually partial and relapses occur in the majority of cases. In HIV-related vasculitides, currently available antiretroviral agents are not able to definitively eradicate the virus but their combination with plasma exchanges can cure the vasculitis. Due to common epidemiologic factors, several viruses can be present in the same patient, and determining their responsibility in the vasculitic process requires careful clinical and virologic analysis and then the selection of a specifically adapted therapeutic regimen. The therapeutic strategy applied in virus-associated vasculitides is therefore based on the etiologic investigations and the choice of a treatment is adapted to the pathogenetic mechanisms.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Giant cell arteritis is associated with a markedly increased risk of aortic aneurysm formation or aortic rupture, particularly in the thoracic aorta. Although this association is not new, it has gained renewed attention recently. In this paper, the nature of aortic aneurysm formation in association with giant cell arteritis is discussed, along with the implications of recognizing large-vessel involvement in elderly patients with giant cell arteritis.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Treatment with glucocorticoids and cytotoxic agents has markedly improved the outcome in patients with systemic vasculitis. As more patients survive with these disorders, the long-term risks of these therapies have become increasingly apparent. An understanding of therapeutic toxicities is important because in some instances they can be minimized by the use of treatment strategies and monitoring techniques. Pneumocystis carinii pneumonia is associated with a high mortality rate in immunosuppressed patients but can be prevented by prophylaxis. Glucocorticoid-related avascular necrosis can incur morbidity affecting employment and daily function. Although treatment options remain limited, investigation into joint salvage procedures has continued. The frequency and longevity of urologic toxicity associated with cyclophosphamide therapy have recently been addressed. Identification of this risk has led to the development of long-term monitoring strategies in cyclophosphamide-treated patients.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Rheumatic diseases have not proved to be more prevalent among neurologic or psychiatric patients than in the general population, except for ostheoarthritis in some chronic disabling neurologic conditions (poliomyelitis, spinal cord injury). Some neurologic entities with relevant musculoskeletal manifestations are described here. The lower prevalence of rheumatoid arthritis in schizophrenia patients is mentioned, and a brief description is presented of somatoform disorders that may confound diagnosis with rheumatic diseases. Factitious disorders and malingering are frequently presented with rheumatic complaints such as low back pain and may have an important impact on the costs associated with the disease. Finally, some of the immune system abnormalities described in major depression and schizophrenia are mentioned with a clear reference to the growing field of psychoneuroimmunology. This paper will not address the issue of neurologic or psychiatric manifestations of rheumatic diseases.

ISSN:1040-8711    

出版商:OVID    

年代:1997

数据来源: OVID