Lupus Symptoms Diagnosis Vasculitis

Systemic lupus erythematosus is a connective tissue disorder in which the immune system creates autoantibodies. White blood cells that are meant to protect the body actually do damage to the tissues of the blood vessels. The blood vessels become inflamed, creating a condition called vasculitis.

Causes of Vasculitis

Vasculitis is further accelerated by low levels of blood cells in the body, another effect of lupus. In the normal body, red blood cells, white blood cells and platelets perform specific tasks. Lupus reduces the number of white blood cells, needed to fight infection, thus increasing the risk of infection. The decrease of red blood cells, necessary for keeping the body oxygenated, is another result of lupus that triggers anemia. Lupus’ depletion of platelets, which allow the blood to clot normally, become compromised in lupus and this can lead to excessive bleeding.

Atherosclerosis: A Complication of Vasculitis

Vasculitis can cause other complications. Inflammation of the blood vessels combined with the autoantibodies present in lupus can lead to blood clots. Some evidence suggests that lupus patients develop plaque in the arteries at a faster rate than normal, increasing their risk of atherosclerosis. Atheriosclerosis refers to the process of fatty substances and cellular waste building up in the inner lining of an artery. Excessive lipid production, often a result of steroid use, can produce plaque and speed up atherosclerosis. The changes that occur to blood vessels as a result of atherosclerosis are thought to be the main contributors of cardiovascular diseases such as heart attack and stroke.

Symptoms of Vasculitis

Vasculitis can affect any blood vessel. In small blood vessels or capillaries, vasculitis can cause the vessels to break and bleed into the surrounding tissue. Red or purple dots appear on the skin. These are called petechiae and occur most often on the legs. Excessive accumulations of petechiae can become skin lesions (ulcers).

In larger vessels, such as those of the hand, vasculitis can reduce blood flow. This reduction of blood flow may be the result of a blood clot, which inhibits circulation to the fingers. Temperature changes can affect the color of the fingers because of the lack of proper blood flow. This is known as Raynaud’s syndrome and is a common symptom in systemic lupus erythematosus as well as in other medical conditions.

In large blood vessels like arteries and veins, vasculitis can cause severe symptoms. The decreased flow of blood can prevent vital organs from receiving an adequate oxygen supply. Without the proper blood supply, tissues can die. Inadequate blood flow to the intestines can lead to cramping and bloating and, if untreated, can cause holes in the intestinal walls. In the eyes, retinal vasculitis leads to retinal damage, causing visual blurring or partial loss of vision. Vasculitis can also headaches, nerve cause tingling or strokes. In other vital organs like the heart, lungs and kidneys, tissue death can be life-threatening due to the failure of vital organs.

Diagnosing Vasculitis

The diagnosis of vasculitis is based on a complete medical history and physical, with emphasis on current symptoms. Blood tests are taken to determine the levels of white and red blood cells, and the sedimentation rate (a measure of the number of oxygen-carrying cells in the blood). Blood tests to detect the presence of autoantibodies may also be performed. Depending on the organs affected, certain imaging tests like CAT scans or x-rays with contrast dyes may be performed. However, analyzing a tissue sample from a biopsy makes the most definitive diagnosis of vasculitis.

Treatment of Vasculitis in Lupus

Although many cases of vasculitis do not require treatment, those hat do and are the result of systemic lupus erythematosus are generally treated with a corticosteroid. In severe cases, cytotoxic drugs may become necessary. Treatment with cytotoxic drugs generally accompanies the use of corticosteroids. The combination is often the most effective method of treatment because it minimizes side effects.

Resources

Beers, M.H.