Vasculitis small vessel

For some autoimmune diseases, little is known about environmental factors involved in the initiation or progression of the disease. For other diseases, however, considerable research has been conducted on one or more types of exposures. Most epidemiologic studies of environmental influences have focused on multiple sclerosis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and small vessel vasculitis, but experimental studies using murine models of these diseases is limited (Table 25.1). 

Harper L, Cockwell P, Savage CO. Case of propylthiouracil-induced ANCA associated small vessel vasculitis. Nephrol Dial Transplant 1998 13(2) 455-8. 

Primary intracerebral hemorrhage is more common than subarachnoid hemorrhage, and its incidence increases with age (see Fig. 1.1). It is more frequent in Southeast Asian, Japanese and Chinese populations than in whites. The most common causes are intracranial small vessel disease, which is associated with hypertension, cerebral amyloid angiopathy and intracranial vascular malformations (Sutherland and Auer 2006). Rarer causes include saccular aneurysms, hemostatic defects, particularly those induced by anticoagulation or therapeutic thrombolysis, antiplatelet drugs, infective endocarditis, cerebral vasculitis and recreational drug use (Neiman et al. 2000 O Connor et al. 2005). 

Renal small-vessel vasculitis related to doxycycline has been reported (16). 

Incidental case reports relate to small vessel vasculitis after combined pneumococcal-influenza immunization... 

Houston TP. Small-vessel vasculitis following simultaneous influenza and pneumococcal vaccination. NY State J Med 1983 83(ll-12) 1182-3. 

OR = Odds ratio ANOA = anti-neutrophil q/toplasmic antibody G = Confidence interval SW = small vessel vasculitis GN = glomerulonephritis ""18 paucHmmune crescentic glomerulonephritis. 9 microscopic polyangitis. 4 Wegener s granulomatosis (Adapted with permission from De Broe et al. [117])... 

Hogan SL, Cooper GS, Savitz DA, Nylander-French LA, Parks CG, Chin H, Jennette CE, Lionakin S, Jennette JC, Falk RJ. Association of silica exposure with anti-neutrophil cytoplasmic autoantibody small-vessel vasculitis a population-based, case-control study. Clin J Am Soc Nephrol 2007 2(2) 290-299. 

Nachman PH, Segelmark M, Westman K, et al. Recurrent ANCA-associated small-vessel vasculitis after transplantation A pooled analysis. Kidney Int 1999 56 1544-1550. 

Vasculitis usually is seen in patients with long-standing rheumatoid arthritis. Vasculitis may result in a wide variety of clinical presentations. Invasion of blood vessel walls by inflammatory cells results in an obliteration of the vessel, producing infarction of tissue distal to the area of involvement. Most commonly, small-vessel vasculitis produces infarcts near the ends of the fingers or toes, especially around the nail beds. These infarcts are usually of little consequence. 

Small vessel disease Vasculitis or arterial sclerosis or congophilic angiopathy A6 L26 CD31 amyloid muscle actin elastin Cerebrum CNS frequent multiple lesions... 

There have also been several cohort and case-control studies of silica exposure and scleroderma (Table 10) and six case-control studies of silica exposure and various forms of systemic small-vessel or ANCA-associated vasculitis. As with rheumatoid arthritis, almost all of these studies have reported a 2- to 3-fold increased risk of these diseases with silica exposure. 

Microscopic polyangiitis (MPA). ANCA-associated necrotizing, pauci immune vasculitis of the small vessels (capillaries, venules, arterioles) frequently associated with rapidly progressive glomerulonephritis and/or haemorrhagic alveolitis as well as autoantibodies against myeloperoxidase. 

Small temporal RNA, see stRNA Small-vessel vasculitis 1195 Smith-Watermami, dynamic programming sequence alignement algorithm 255 SMP-140 477 Snakin proteins 485 SNaPshot 84 Snell law 1218... 

Hogan et al. 2001 [76a] 65 cases with ANCA-associated small vessel vasculitis 65 age/sex-matched other renal failure patients Silica dust 4.4 (1.36-13.4)... 

Wegener s granulomatosis is a necrotizing vasculitis of small vessels of unknown etiology. It is usually treated with immunosuppressive drugs resulting... 

Hypersensitivity vasculitis induced by drags is another manifestation of a type III response. Drags involved include some p-lactams, particularly, amoxicillin and cephalexin, cotrimoxazole, NSAIDs, monoclonal antibodies, and chemotherapeutic drags such as tamoxifen and erlotinib. A proportion of small-vessel vasculitis patients have anti-neutrophil cytoplasmic antibodies. Although there is evidence of a pathogenic role for these antibodies and they are used as a diagnostic marker, operative mechanisms underlying this hypersensitivity state are still far from established. 

Fig. 11.1 Palpable purpura in a patient with hypersensitivity vasculitis (leukocytoclastic vascuhtis), a small vessel vasculitis usually involving post-capillary venules in the dermis. This cutaneous manifestation of vasculitis occurs occasionally following treatment with mAbs and some other biologic agents (Photograph of Dr. John Stone) (Reproduced with permission from Weyand CM, Goronzy J, in Klippel JH, Stone JH, Crofford LeJ, White PH, editors. Primer on the Rheumatic Diseases, 13th ed. New York Springer, 2008)...

Necrotizing vasculitis with few or no immune deposits affecting small vessels, i.e., capillaries, venules, or arterioles. Necrotizing arteritis involving small and medium-sized arteries may be present. Necrotizing glomerulonephritis is very common. Pulmonary capillaritis often occurs. 

Hogan SL, Ealk RJ, Chin H, et al. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 2005 143 621-631. 

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