Inflammatory Vascular Diseases: Classification

by Joseph Alpert, MD

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    00:01 a very, very serious condition in many individuals.

    00:01 There are three different ways to classify vasculitis. One can classify based on the underlying cause. One can classify it based on the type of vessel involved, artery or vein. Or one can talk about the size of the affected vessel. This is usually for arteries - small arteries, medium-sized arteries, or large arteries. Let's look at some of the specific kinds of events that can occur in terms of the underlying cause when we define vasculitis. There is primary vasculitis and secondary vasculitis with respect to underlying causes. Primary is direct injury from a virus or from trauma. Infectious agents are varied.

    00:50 It could be bacteria. It could be a whole bunch of different viruses much more commonly it is an autoimmune process where the body mistakenly begins to attack the vessel. Secondary causes are due to other illnesses. The most common is a collagen vascular disease such as lupus erythematosus but there are other immunological mediated disease, scleroderma and so forth usually falling in the category of collagen vascular disease and that is why this form of vasculitis is often cared for by a rheumatologist. In some individuals the injury that starts the vasculitis can be cold, for example patients with Raynaud’s disease we already discussed that, or there can be mechanical injury or there can be toxins, particularly with industrial exposure. It turns out that arsenic is a very common cause of arteritis.

    01:46 It depends also in classification to know which type of vessel is affected. Is it the arteries or is it the veins? With the arteries, is it the result of an autoimmune process? Is it the bodies own immune system that is doing this? Or is it some kind of infection.

    02:04 On the venous side we have already talked about this extensively in previous lectures.

    02:08 It can be caused by local trauma thereby injuring the vein. It can be caused by hypercoagulability in combination with the local injury and by stasis and of course as we talked about in last lectures it can result in DVT, deep venous thrombosis and pulmonary embolism.

    02:27 Let's look at some examples. One common form of arteritis, we often don’t think of it as an arteritis is atherosclerosis. Why is this an arteritis? Because it begins with an inflammatory process. Of course when we see it the inflammation may still be ongoing but the case is very complicated because there has been scarring and collection of fibrous tissue and lipids and calcium in the artery so we often don’t think of this as an inflammatory disease. Inflammatory artery disease are usually solely inflammation where as in arthrosclerosis of course the process begins as inflammation but goes on to lead to the typical atherosclerotic lesion. In phlebitis, deep venous thrombosis and pulmonary embolism, the presence of the thrombus in the vein is also an inflammatory cause. Often there is an injury to the vein wall for example with surgery or it could even be from some form of infection. This generates an inflammatory response in the vessel wall. This leads to increased likelihood of clot forming there and of course as we talked about in previous lectures this can go on to embolization of a clot to the lungs resulting in pulmonary embolism. The size of the affected vessel is also very important in terms of the categorization of vasculitis.

    03:53 And here we are usually talking about arteries, either small arteries medium sized arteries, or large arteries. And I am going to talk about each of the diseases that occur in these areas.

    04:06 Let's start by talking about small vessel vasculitis. There are two common forms of small vessel vasculitis, microscopic polyangiitis and Wegner’s granulomatosis. Again these are usually cared for by rheumatologist because they often occur in the setting of a collagen vascular disease or they are initially mistaken as a collagen vascular disease. And also, rheumatologists or experts in the use of anti inflammatory and immune-mediated drug such as steroids.

    04:43 So let's talk about microscopic polyangiitis. This is a small vessel vasculitis. It involves very small arteries. It was initially thought to always be an immune complex disease but very few immune deposits complexes are found in pathological biopsies. It usually affects small vessels but might spread to medium-sized vessels. It's often associated with damage to the glomerulus in the kidney, and can lead to kidney failure and dialysis and there can often be pulmonary involvement as well. Goodpasture syndrome is part of this syndrome.

    05:21 The second form of small vessel vasculitis is Wegner’s granulomatosis. Wegner’s is a very insidious, a very unpleasant disease. It affects the respiratory lining of the sinuses and sometimes the upper airways of the lungs, again associated with a glomerulonephritis that can lead to kidney failure and the arteries of both the mucosa and sinuses and in the kidney are often involved. A very serious disease often treated very aggressively with anti-immunological drugs such as Immuran and steroids.

    06:04 Medium-sized vessel vasculitis, commonest one here in North America and Western Europe is polyarteritis nodosa. Polyarteritis is the most common of the medium-sized vasculitides.

    About the Lecture

    The lecture Inflammatory Vascular Diseases: Classification by Joseph Alpert, MD is from the course Inflammatory Vascular Diseases.

    Included Quiz Questions

    1. By vessel size
    2. By the shape of the vessel
    3. By the quantity of blood flow carried by the vessel
    4. By quality of the vessel endothelium
    1. Lupus erythematous
    2. Direct injury
    3. Bacteria
    4. Virus
    5. Autoimmunity

    Author of lecture Inflammatory Vascular Diseases: Classification

     Joseph Alpert, MD

    Joseph Alpert, MD

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