Talk:Vasculitis

Would

Would atherosclerosis qualify as a vasculitis ? There is a lot of inflammation, too.
PFHLai 13:13, 2004 May 20 (UTC)

Okay, please make it more specific. Atherosclerosis is not considered vasculitis, really... JFW | T@lk 18:40, 20 May 2004 (UTC)

Atherosclerosis vs Vasculitis

Frankly, Dr. Wolff, I don't know much about Atherosclerosis or Vasculitis. I was hoping to find out their differences from this page on Vasculitis, or the one on Atherosclerosis. Based on what I have read so far, I am under the impression that:

1. vasculitis is rare, whereas a person without atherosclerosis is more rare
2. endothelial dysfunction does not seem to be involved in vasculitis, whereas atherosclerosis and endothelial dysfunction have a "chicken-&-egg" relationship -- no one knows which one starts first ...
3. fatty deposits in all atherosclerotic lesions, but not in vasculitis
4. vasculitis is severe and acute, but can be cured, whereas atherosclerosis progresses silently, is chronic and is irreversible.
5. the odd patient with vasculitis seeks medical attention for the inflammation and the associated pain and fever, whereas patients with atherosclerosis need medical attention for serious problems secondary to the lesion: stroke, chest pain due to cardiac insufficiency, etc. (often too late)

Am I correct ? Should atherosclerosis be considered a special case of slow-progressing vasculitis that is induced/accelerated by fatty deposits in the vessel wall ? Can vasculitic lesions in at a young age become or induce atherosclerotic lesions later in life ? I am looking forward to reading more on vasculitis as your page on this disease grows. Thank you.
PFHLai 03:36, 2004 May 21 (UTC)

Patrick, most of this stuff is still quite new for me, and I'm learning about vasculitis by working on this stuff. I can therefore not really answer your questions.

Still, it appears that vasculitis and atherosclerosis are two different processes which overlap. Vasculitis patients do suffer from accelerated atherosclerosis (the typical lupus patient dies vascularily) and there are plenty of theories that claim atherosclerosis is a chlamydial disease. I wouldn't doubt for a moment that vasculitis causes endothelial dysfunction.

A review we might both have to read is: Juvonen T, Juvonen J, Savolainen MJ. Is vasculitis a significant component of atherosclerosis? Curr Opin Rheumatol 1999 Jan;11:3-10, PMID [9894624.

I hope we can clarify this together. I find wiki-editing an educational experience for reasons like these! JFW | T@lk 09:14, 21 May 2004 (UTC)

Oh, yes, Dr. Wolff, wiki-editing has been a very good educational experience for me, too. But I have been spending more time reading than typing. Let me read more and I'll see what I can add.

I agree that vasculitis and atherosclerosis are two different processes which overlap. An atherosclerotic lesion is indeed a blood vessel with inflammation, i.e. 'vascul' + 'itis'. Before I saw your page on vasculitis, vasculitis and atherosclerosis were the same thing to me ! I am still under the impression that atherosclerosis is a slow-progressing form of vasculitis involving lipid deposits in the vessel wall. I don't know much about the chlamydia hypothesis, but I think any significant damage to the endothelium, such as a chlamydia infection in the vessel wall, may lead to atherosclerosis. I'd better read more ...

Thank you for the reference by Juvonen et al..

PFHLai 17:10, 2004 May 21 (UTC)

Vasculitis is definitely a distinct process, and the main question (addressed by Juvonen et al and in lots of other work) and whether atherosclerosis is a form of vasculitis or not. The nomenclature is confusing, of course there is inflammation of the vessel wall in atherosclerosis... Interestingly, a recent clinical trial failed to prove effectiveness of antichlamydial antibiotics in atherosclerosis patients... JFW | T@lk 10:22, 23 May 2004 (UTC)

Names of more people who died from Vasculitis needed

Can anyone think of anyone other than Janet Leigh who have died from any type of Vasculitis? --198.164.135.37 12:42, 4 Oct 2004 (UTC)

I dispute the need for such a list. We don't list all people who have died from a myocardial infarction (heart attack), or do we? Vasculitis is quite an esoteric type of diseases, and is rarely mentioned as a cause of death in obituaries so as not to confuse the readership.

As far as I'm concerned, Janet Leigh does not need to be mentioned on this page. JFW | T@lk 20:08, 4 Oct 2004 (UTC)

Why do we need such a list on any disease page anyways? Andrewr47 01:20, 12 April 2006 (UTC)

My Child Ryvor Nathon Loyd Anderson May 25 1996 - Dec 3 2006 Passed away At Childrens Hospital in Seattle Washington, due to a condition called Central nervous System Vasculitis of Childhood. The Center for Disease Control, Was the Authority in Conjunction with the King County Medical Examiner. Why the need for names? I found out my son is one of less than 25 in the world. This disease is only found through Autopsy or Brain Biopsy. His symptoms throughout life mimicked And included Cerebral Palsy, Headaches, No weight gain, muscle aches, and finally personality change. His IQ on RECORD is in math 2Xs national average in 2006. No intelligence change was apparent. My child exhibited a early learner attitude born early, and to a prednisone dependent asthmatic mother; born approximately 33 weeks due to increased heartrate. The end result is He appeared to have a stomach flu, and never appeared to regain full consciousness, however motor control allowed for moving him down the hall, an hour later my child became rigid, and was rushed to ER in Everett WA, Transferred To Childrens at Sand Point or Seattle WA. I witnessed swelling then of his eyes, remaining fixed, I held him as they unplugged the Ventilator, and as in birth delivered him into the hands of God, so to speak. I see him often. And know without a doubt one life is missed. That's why I am giving you, a name of who passed into life after death. DA_Anderson@ymail.com have a good day —Preceding unsigned comment added by AngeliaBettina (talk • contribs) 21:33, 11 October 2010 (UTC)

External links

This is my first edit and I hope my addition of an "external links" section is appropriate. I thought there was a need for a link to the Johns Hopkins page because it contains a lot of valuable information. --Cameleopard 17:19, 18 July 2005 (UTC)

Do you have any expertise in vasculitis? Could you contribute further to the topic? JFW | T@lk 17:25, 18 July 2005 (UTC)

I have no professional knowledge about vasculitis; I'm not even in any medical field. My knowledge is limited to what I have been told and read, as a relative was recently diagnosed with primary angiitis of the central nervous system (which is a newer name for primary granulomatous vasculitis or granulomatous angiitis; there is also benign angiopathy of the central nervous system). There are a few relatively minor things that I've read that may, perhaps, suggest a need for alteration or the insertion of conditionals in the wikipedia article. For instance, it seems there may be too much certainty expressed in the sentence attributing causes to autoimmune disorders and infections as everything I've read indicates these are at best suspected (additionally, the role of infection-induction may be greater than indicated, in fact causing hyperactivity of the autoimmune system). Also, areas of the article could be fleshed out a bit. For instance, angiography and CT scans are common diagnostic tools (and in the case of CNS vasculitis, cerebral arteriography). Lastly, I'm not sure what the preferred procedure for medical entries on the Wikipedia is, but a couple of sentences on the history of vaculitis might be nice, indicating its rarity, its high mortality rate until recent developments in treatment, and the relative crudeness of treatment. I can initiate such additions to the article if desired, but I just want to be clear that I am by no means an expert. I'm presently looking up peer-reviewed articles on vasculitis. --Cameleopard 04:04, 19 July 2005 (UTC)

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Atherosclerosis = Vasculitis (FINAL STAGE)

Atherosclerosis – an Inflammatory Process:

Atherosclerosis is characterized by a non-specific local inflammatory process which is accompanied by a systemic response. A number of prospective studies in initially healthy subjects and in patients with known atherosclerosis have convincingly demonstrated a strong and independent association between even slightly elevated concentrations of various systemic markers of inflammation and a number of cardiovascular events. C-reactive protein (CRP), the classical acute phase protein, seems to be the marker of choice in this clinical situation. The measurement procedure is well standardized and automated, high-sensitivity assays with sufficient precision are available. In addition, recent research has suggested that CRP may not only be a risk marker, but may be directly involved in the pathogenesis of atherosclerosis. Various lifestyle changes and pharmacological interventions are able to reduce elevated CRP concentrations. Testing the inflammation hypothesis should be of major importance in clinical research of atherosclerosis.

Deutsches Ärzteblatt 100, Ausgabe 3 vom 17.01.2003, Seite A-117 / B-108 / C-105 MEDIZIN (Germany)

G.S., MD (Germany)

We've discussed this before. Atherosclerosis has some things in common with "classical vasculitis", but appears to be a pathogenetically distinct entity. For one thing, the immune process alone does not account for atherosclerosis. Treatments normally used for vasculitis do not exhibit great effect on the progress of atherosclerosis and even tend to exacerbate it (would you give IV methylprednisolone to an acute case of atherosclerosis?) I don't think Wikipedia should be in the business of expousing this view where medical opinion seems to be against it. JFW | T@lk 21:58, 27 October 2005 (UTC)

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OK.

We discuss this under the term (unter dem Begriff)

"Tilt-Vasculitis",

e.g. "DIV" = "Drug-induced Vasculitis" etc.: "DIV is a relatively common cause of inflammatory vasculitis. Drugs from almost every pharmacologic class have been implicated in causing vasculitis in sporadic cases. The level of certainty and quality of evidence for these associations between specific agents and vasculitis vary greatly. The clinical manifestations of DIV range from single organ involvement (most commonly, skin) to life-threatening multiorgan disease." Merkel PA / Rheum Dis Clin North Am. 2001 Nov;27(4):849-62.

or

"TOS" / Toxic-Oil-Syndrome: Spain 1981: Histopathological = a systematic, non necrotizing vasculitis..

or

TILT = Toxicant-induced Loss of Tolerance (Miller & Ashford 1996/98),

TILT-Syndrome & Tilt-Vasculitis:

"The clinical syndromes produced by pollutants are myriad. Some are named and others are not. Discussed separately are small vessel vasculitis, large vessel vasculitis, carotid spasm, Raynaud’s disease, hypertension, specific systemic undifferentiated Tilt-hypersensitive vasculitis, Panarteriitis nodosa, Wegener’s granulomatosis, rheumatoid vasculitis, recurrent phlebitis and thrombophlebitis, thrombosis etc."

"Many necrotizing and non-necrotizing vasculitides are directly caused or closely associated with immunopathogenic mechanism and environmental triggers. It was originally thought that the mechanism most commonly associated with Vasculitis is that of the deposition of circulating immune complexes in the blood vessel walls. However, this association appears to be limited since com-plexes are not always necessary for inflammation of vessels to occur. In fact, a larger percentage of blood vessels deregulation in the hypersensitive (pseudoallergic, intolerant) patient appears to occur through non-immune mechanism." ...

G.S., MD, Germany EU

Cultural References

With respect to the "Cultural References" section of the article, my friend with vasculitis told me that the reason Dr. House refers to it a lot is because a vasculitis society paid NBC to raise awareness about the disease.

Polyarteritis Nodosa

The symptoms of Polyarteritis Nodosa listed on this page don't really match the symptoms described in the main article on Polyarteritis Nodosa... I think the diagnositc criteria listed here are probably more accurate, maybe this needs adding to the other page?

way too technical

this really really needs to be made more accessible. it reads like something out of medical school rather than a standard wikipedia article. I wouldn't doubt the information as it certainly does sound authoritative and correct when presented like this... however, I don't think most people will really be able to understand it! it's got way too much medical jargon and the writing style is choppy.

I tend to agree. I clicked on Leukocyte and was redirected to White blood cell. Wikipedia is NOT a resource for medical students. I hope! 202.7.183.131 (talk) 12:39, 23 April 2008 (UTC)

Harold Ramis & autoimmune inflammatory vasculitis

According to this Chicago Tribune article, http://www.chicagotribune.com/entertainment/chi-harold-ramis-dead-20140224,0,2259309.story , Mr Ramis died of "autoimmune inflammatory vasculitis". Is this one of the vasculitis conditions covered by the article, though I don't find the term there. In fact, no "autoimmune" anything is mentioned. As people become aware of his death, more will probably browser-search the term and expect WP to address it. Is there another article that covers it that I cannot find by searching WP? Thank you, Wordreader (talk) 19:05, 24 February 2014 (UTC)

Proposed changes

I wanted to discuss this before I make any major edits as this is a very popular page. I recently had a discussion on the medicine wikiproject regarding better classifications of the different types of vasculitis. I propose that we make a seprate section for classification as it's more relevant to this topic. I've also reformatted the classification to fit the most recent guidelines. My sandbox can be viewed here if anyone has any feedback. CursedWithTheAbilityToDoTheMath (talk) 17:42, 14 January 2024 (UTC)

Support, looks very organized and it matches with the (good) source used. I would suggest expanding the Secondary Vasculitis section, perhaps with a bulleted list of possible causes. The 2012 source, at the least, lists out some of those causes. Just-a-can-of-beans (talk) 22:48, 14 January 2024 (UTC)

Sounds good. I'll do some work on the secondary vasculitis section. CursedWithTheAbilityToDoTheMath (talk) 23:05, 14 January 2024 (UTC)

Signs and symptoms

I'm looking at improving this page a bit, starting with the signs and symptoms category. The problem I've encountered is how to organize this section. It's currently organized based off organ systems, which I don't have an issue with except for the fact that it's very hard to find a source that organizes the symptoms this way, and it doesn't really make sense since, for example, blindness is only a symptom of one kind of vasculitis, so just listing it as a symptom doesn't make much sense since most forms of vasculitis don't cause blindness. The other two ways we could categorize symptoms are either based on the size of vessel involved, like how we organized the classification, or by specific disorder. I think it would be easiest to list symptoms based on the individual disorders; the only issue I see with that is the overlap in symptoms. I'm interested in others views here, and if anyone has any input, that would be greatly appreciated. CursedWithTheAbilityToDoTheMath (talk) 16:16, 8 August 2024 (UTC)

I wonder if it really needs to be structured as a list? It would make sense to me to note that different organ systems can be affected, and that different conditions give rise to different symptoms. (Also, I'm not really sure that blindness is only caused by one type of vasculitis, I've seen it in both Takayasu's and temporal arteritis.)

That saves a lot of work necessitating only one paragraph, and avoids being confusing. CFCF (talk) 14:58, 13 August 2024 (UTC)

@CFCFGood point. Also adding the symptoms for each would cause the page to be very long. I have started a sandbox for the article at User:CursedWithTheAbilityToDoTheMath/sandbox3 do you think what I currently have for the symptoms section would be enough? I was also thinking of adding a bit about skin symptoms, mostly purpura, since they are classically associated with vasculitis and since the photo for the article features purpura. Something along the lines of "most vasculitis presents with purpura" but better worded. I do have specefic referance in mind for this (Shavit, Eran; Alavi, Afsaneh; Sibbald, R. Gary (2018). "Vasculitis—What Do We Have to Know? A Review of Literature". The International Journal of Lower Extremity Wounds. 17 (4): 218–226. doi:10.1177/1534734618804982. ISSN 1534-7346.) as it kinda phrases this nicely. CursedWithTheAbilityToDoTheMath (talk) 23:46, 13 August 2024 (UTC)

I think the section you wrote is a good start. However, I wonder if we want to note that the etiology is also dependent on which part of the vessels is affected, and which location in the body the inflammation chiefly arises (all these varying depending on disease). It is not entirely correct to state that size and diameter of affected vessels is the only thing to matter, but rather to note that this is the traditional and generally accepted categorization which in turn is based off of symptomatology. I think it should be noted that many large-vessel vasculides are in their turn due to inflammation in the miniscule vessels of the vasa vasorum. A really good starter may be doi:10.1056/NEJMra022694, even though it is a little old it seems to be quite acceptable regarding symptomatology, and we could refer to the following:

Giant-cell arteritis typically causes vasculitis of the extracranial branches of the aorta and spares intracranial vessels. Transmural inflammation of the arteries induces luminal occlusion through intimal hyperplasia. Clinical symptoms reflect end-organ ischemia. 3,6,7 Branches of the external and internal carotid arteries are particularly susceptible. Their involvement leads to the classic manifestations of blindness, headache, scalp tenderness, and jaw claudication. Vasculitis of the vertebral arteries can impair the posterior cerebral circulation and cause stroke, transient ischemic attacks, vertigo, and dizziness. Involvement of the subclavian, axillary, and proximal brachial arteries leads to the aortic arch syndrome of claudication of the arms and absent or asymmetric pulses. 8 Whereas giant-cell arteritis of medium-sized arteries results exclusively in narrowing and obstruction of vessels, the clinical complications of aortitis, which most often occurs in the thoracic aorta, are aneurysm formation, dissection, hemorrhage, and rupture. 9,10

In almost all patients with giant-cell arteritis, a syndrome of systemic inflammation accompanies vascular manifestations. The nonspecific symptoms include malaise, anorexia, weight loss, fever, night sweats, and depression. In patients with highly elevated acute-phase responses, such as a high erythrocyte sedimentation rate and increased levels of C-reactive protein, these symptoms are important clues to the diagnosis. Signs of systemic inflammation are also present in patients with polymyalgia rheumatica, a disorder characterized by severe myalgias and stiffness of the muscles of the neck, shoulder girdle, and pelvic girdle. About 30 to 40 percent of patients with giant-cell arteritis also have polymyalgia rheumatica. The two conditions affect the same population of patients, have the same genetic risk factors, 11 and have similar patterns of acute-phase responses. 12

etc..

There is also this doi:10.1161/CIRCULATIONAHA.120.046657, which gives symptoms more based on subtype.

NIH is also a good starter at [1]

Further, I am in general against statements where we say "most", rather than "many". I am unsure whether it can actually be said that most vasculides present with purpura. CFCF (talk) 11:39, 14 August 2024 (UTC)

I note that in general this page is lacking information on infectious vasculides, inlcuding implication in pathogenesis or infection-associated vasculides. Some starters may be doi:10.1080/08916930802613210, doi:10.1111/1756-185X.13287 or doi:10.1186/s12894-021-00886-5. For a differential diagnosis section one may use: doi:10.1093/rheumatology/keaa495. CFCF (talk) 11:51, 14 August 2024 (UTC)

@CFCF Sorry if I made this unclear before, but I wasn't actually going to put "most vasculitis presents with purpura" in the article. I was thinking something along the lines of "All forms of vasculitis, even large vessel vasculitides, may cause skin manifestations. The most common skin manifestations include purpura, nodules, livedo reticularis, skin ulcers, and purpuric urticaria.

Regarding your first point about the causes of vasculitis, I agree the article needs to be improved quite a bit so thank you for providing those resources as they will be a great help to me in writing this article. CursedWithTheAbilityToDoTheMath (talk) 13:18, 14 August 2024 (UTC) CursedWithTheAbilityToDoTheMath (talk) 13:18, 14 August 2024 (UTC)

Sounds excellent, keep up the good work! CFCF (talk) 15:44, 16 August 2024 (UTC)

References