Inflammatory Diseases of Blood Vessels (eBook)

Gary S. Hoffman, Cornelia M. Weyand, Carol A. Langford, Jorg J. Goronzy (Herausgeber)

eBook Download: PDF

2012 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-118-35526-8 (ISBN)

Infos

In recent years, considerable progress has been made in understanding the vasculitic diseases, largely due to the introduction of effective treatments for diseases that were once uniformly fatal, the conduct of structured clinical studies, and advances in immunology and molecular biology. Despite these achievements, the vasculitic diseases continue to be associated with morbidity and mortality from chronic organ damage, relapses, and the side effects of treatment. Investigations into the mechanisms of vascular inflammation may lead to a better comprehension of the pathogenesis of vasculitic diseases and to treatment that is more effective and less toxic. These areas of promising research, together with current knowledge about the vasculitic diseases, are extensively examined in this new edition, which is designed to provide a comprehensive overview of the science and clinical consequences of vascular inflammation in health and disease.

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Inflammatory Diseases of Blood Vessels Inflammatory Diseases of Blood Vessels Second Edition Inflammatory Diseases of Blood Vessels provides a comprehensive overview of the science and clinical consequences of vascular inflammation in health and disease. In recent years, considerable progress has been made in understanding different forms of vasculitis. Investigation of pathogenesis of vascular inflammation has led to improved treatments and outcomes. Surgical and transplant procedures have improved in parallel with medical therapies. These areas are extensively examined in this new edition. Inflammatory Diseases of Blood Vessels is an excellent resource for a broad readership, including clinicians, investigators and their support teams in numerous specialties e.g. rheumatology, immunology, cardiology, cardiovascular surgery, pulmonary medicine, nephrology, pathology, vascular biology, embryology and imaging.

Autor

Edited by Gary S. Hoffman MD, MS Professor of Medicine Department of Rheumatic and Immunologic Diseases Center for Vasculitis Care and Research Cleveland Clinic Lerner College of Medicine Cleveland, OH, USA Cornelia M. Weyand MD, PhD Professor of Medicine Stanford University School of Medicine Stanford, CA, USA Carol A. Langford MD, MHS Director, Center for Vasculitis Care and Research Department of Rheumatic and Immunologic Diseases Cleveland Clinic Lerner College of Medicine Cleveland, OH, USA Jörg J. Goronzy MD, PhD Professor of Medicine Stanford University School of Medicine Stanford, CA, USA

Inhalt

Inflammatory Diseases of Blood Vessels 3
Contents 7
List of Contributors 9
Preface 16
PART I Biology of Blood Vessels and Mechanisms of Vascular Inflammation 17
CHAPTER 1 Vascular Development 19
Development of the cardiovascular system 19
Endothelial cell heterogeneity and organ specificity 23
Arterial and venous endothelial cell distinctions 24
Lymphatic capillaries 25
Blood–brain barrier 27
Implications of vascular diversity for disease expression and therapy 28
Demonstrated or accepted 28
Hypothetical 28
Conclusions 29
Acknowledgments 30
References 30
CHAPTER 2 Vascular Repair 31
Introduction 31
History 31
Embryonic development 32
Initial stimulus of arteriogenesis 32
Role of physical factors 32
Growth factors 35
Role of bone marrow derived cells 35
Morphology and remodeling of collateral arteries 36
Proliferative phase 37
Synthetic phase 37
Maturation phase 37
Tunica interna – the endothelium 37
Tunica media – smooth muscle cells 37
Tunica externa – the adventitia 38
Pathways involved in arteriogenesis 38
Fluid shear stress sensing – calcium signaling – Trpv4 38
The actin cytoskeleton – Abra 40
Phenotypic switch – fetal gene program 41
References 42
CHAPTER 3 Leukocyte Trafficking 44
Introduction 44
Leukocyte recruitment cascade 44
Tethering and rolling 44
Activation and firm adhesion 45
Intraluminal crawling 46
Transendothelial migration (diapedisis) 46
Migration through tissues 47
Normal trafficking of leukocyte subsets 47
Granulocytes 47
Monocytes, macrophages, and dendritic cells 49
Lymphocytes 50
Microvascular traffic control 50
Clinical implications of leukocyte trafficking as a therapeutic target 52
Antiadhesion molecule therapies 52
Therapeutic targeting of chemoattractants 53
Conclusions 53
References 53
CHAPTER 4 Dendritic Cells and Vascular Inflammation 55
Functions of DC in the immune system 56
VasDC – defining the immunologic identity of arteries 57
VasDC in vasculitis 59
DC in atherosclerosis 61
VasDC as therapeutic targets in inflammatory vasculopathy 63
References 64
CHAPTER 5 T Cells and Vascular Inflammation 66
Introduction 66
Principles of T-cell biology 67
Antigen specificity 67
T-cell generation and homeostasis 67
T-cell activation 68
T-cell differentiation and function 68
T cells in vascular inflammation 70
Genetic risk factors of vascular inflammation 70
T-helper cell function for autoantibody production 71
T-cell cytokine pathways in vascular inflammation 71
T regulatory cells in vascular inflammation 72
End-differentiated effector T cells in vascular inflammation 72
T-cell-targeted therapy 73
T-cell depletion 73
Targeting TCR stimulation and signaling 74
Inhibition of co-stimulation 74
Inhibition of cytokine signaling 75
Neutralization of T-cell-derived cytokines 75
Conclusions 75
References 76
CHAPTER 6 Autoantibodies and Vascular Inflammation 77
Introduction 77
Antineutrophil cytoplasmic antibodies 78
Antigenic specificities and method of detection 79
Associations of PR3-ANCA and MPO-ANCA with clinical disease entities in systemic vasculitis 80
Pathogenicity of ANCA 80
Therapeutic implications 82
Anti-cPR3 antibodies 82
Anti-LAMP-2 antibodies 82
Antiendothelial cell antibodies 83
Methods of detection 83
Endothelial antigens 83
Disease associations 83
Pathogenetic role 84
References 85
CHAPTER 7 Neutrophils and Vascular Inflammation 87
Introduction 87
Neutrophils in the ANCA associated vasculitides 88
Neutrophil effector functions 93
Conclusions 95
References 96
CHAPTER 8 Cytokines and Vascular Inflammation 98
Introduction 98
Cytokines in the pathogenesis of vascular inflammation 99
Cytokines in early phases of vascular inflammation 99
Inflammatory infiltration of the vessel wall and amplification mechanisms 102
Cytokines and growth factors in vascular regeneration and remodeling 104
Angiogenesis 104
Vascular remodeling 105
Translational impact of cytokine research in systemic vasculitis 106
Common genetic variants in cytokine genes and disease susceptibility 106
Cytokines as biomarkers of vascular inflammation 106
Cytokines as therapeutic targets 107
Acknowledgments 107
References 108
CHAPTER 9 Oxidative Stress and Vascular Inflammation 110
Reactive oxygen species 110
Oxidative stress – old vs. new concepts 110
Sources of reactive oxygen species 111
NADPH oxidases 112
Mitochondrial electron transport 112
Xanthine oxidase 112
Uncoupled nitric oxide synthase 113
Interplay between sources or reactive oxygen species 113
Relationship between oxidation and inflammation 113
Oxidative stress and inflammation in atherosclerosis 115
Effect of early atherosclerosis/ hypercholesterolemia on vascular oxidative stress 115
Early events in atherosclerosis 115
Progression and advanced stages of atherosclerosis 115
Vascular inflammation in hypertension 117
Vascular inflammation in diabetes, obesity and the metabolic syndrome 118
Failure of current therapies and future directions 118
References 119
CHAPTER 10 Hemostasis and Vascular Inflammation 121
Overview of hemostasis and its regulation 121
Thrombin–thrombomodulin leads to activation of protein C and plasma procarboxypeptidase 124
Anti-inflammatory role of plasma carboxypeptidase B 125
Lectin domain of thrombomodulin and its effect on myeloid dendritic cells 128
Other platelet mediators 129
Conclusions 129
References 129
CHAPTER 11 Animal Models of Vasculitis 131
General aspects of animal models of vasculitis 131
Immune complex-associated vasculitis models 132
Vasculitis models mediated by adaptive immunity against vascular components 134
ANCA associated vasculitis models 135
Cytokine-mediated vasculitis models 135
Infectious agent-associated vasculitis models 135
Autoimmune-mediated vasculitis models/lupus models 136
Polygene models of vasculitis 137
Conclusions 140
References 140
CHAPTER 12 Arteries, Smooth Muscle Cells and Genetic Causes of Thoracic Aortic Aneurysms 142
Structures of arteries: elastic versus muscular 142
VSMCs and their diverse roles in the vascular system 145
Thoracic aortic aneurysms and acute aortic dissections: causative mutations disrupt smooth muscle function 147
References 149
CHAPTER 13 Innate Immunity in Atherosclerosis 152
Introduction 152
Initiation and progression of atherogenesis 153
Potential role of foreign pathogens in atherosclerosis 153
Immunity and host defense 154
Toll-like receptors: front-line defense against pathogens 154
TLRs participate in atherosclerosis 155
TLRs expression and atherosclerosis 155
Genetic variants of TLRs and atherosclerosis 155
TLRs and atherosclerosis: animal experiments 155
Exogenous TLR ligands implicated in the progression of atherosclerosis 156
Endogenous TLR ligands and atherosclerosis 158
Cross-talk between TLRs and lipid metabolism by liver X receptor 158
TLRs, dendritic cells and atherosclerosis: the critical link? 158
Future therapy: Re-engineering immune defenses 160
Acknowledgments 161
References 161
CHAPTER 14 Adaptive Immunity in Atherosclerosis 163
Immune cells at different stages of atherosclerosis 164
Innate and adaptive immunity 165
Innate immunity 165
Adaptive immunity 166
Regulatory T cells control autoimmunity 167
Role of the immune system in animal models of atherosclerosis 167
Animal models of atherosclerotic disease 167
Atherosclerosis is accelerated by Th1 immunity 168
Th2 and Th17 cells may have a multifaceted role in atherosclerosis 168
CD4+ versus CD8+ T cells in atherosclerosis 169
NKT cells respond to lipid antigens 169
Tregs are atheroprotective 170
B cells and antibodies 170
Therapeutic potential of immune modulation in atherosclerosis 170
Conclusions and clinical perspectives 172
Disclosures 172
References 172
PART I I Primary Autoimmune Vascular Disease 175
CHAPTER 15 Historical Perspectives of Vasculitis 177
Polyarteritis nodosa 177
Microscopic polyarteritis 180
Henoch–Schönlein purpura 181
Granulomatosis with polyangiitis (Wegener’s) 181
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) 182
Giant cell arteritis 182
Takayasu’s arteritis 183
Behçet’s syndrome 184
Kawasaki disease 184
Classification of vasculitis 184
References 185
CHAPTER 16 Approach to the Differential Diagnosis of Vasculitis 186
Introduction 186
Overall approach to diagnosis of vasculitis 186
Large vessel vasculitis 187
Aortitis 187
Temporal arteritis 191
Medium vessel vasculitis 192
Infectious mimics 192
Hypercoagulable states 192
Arteriographic mimics 193
Segmental arterial mediolysis 194
Grange syndrome 194
Small vessel vasculitis 195
Pulmonary–renal syndrome 195
Rhinosinusitis 197
Cutaneous vasculitis 198
Conclusions 198
References 198
CHAPTER 17 Imaging of Medium and Large Vessels (CT/MR/PET) 200
Computed tomography 200
Magnetic resonance imaging 201
Fluorodeoxyglucose positron emission tomography 206
Key concepts supported by multiple studies 207
Implications 207
New opportunities for future investigation 208
References 208
CHAPTER 18 Kawasaki Disease 210
Introduction 210
Demographics 210
Clinical features 212
Laboratory features 213
Imaging features 214
Histopathology 215
Etiology 215
Pathogenesis 216
Treatment 216
Refractory disease 218
Treatment options in those with coronary artery aneurysms 219
Conclusions 219
References 219
CHAPTER 19 Henoch–Schönlein Purpura 221
Introduction 221
Classification criteria 221
Epidemiology 221
Clinical features 222
Children 222
Adult HSP 224
Laboratory evaluation 224
Imaging 225
Pathology 225
Etiology 225
Genetic factors 226
Environmental factors 226
Pathogenesis (Figure 19.5) 226
Evidence for involvement of group A streptococcus 226
Inflammatory pathways 226
Immune complex deposition related to aberrant IgA glycosylation 227
Treatment 228
Symptomatic and supportive treatment 228
Role of corticosteroids 228
Other therapies 228
Treatment of persistent nephritis 229
Treatment of severe or rapidly progessive renal disease 229
Future potential therapies 229
Prognosis 229
Recurrence 230
Prognosis of HSP nephritis 230
Pregnancy 230
Conclusions 230
References 231
CHAPTER 20 Polyarteritis Nodosa 233
Introduction 233
Epidemiology 233
Clinical presentation 234
Pathology 237
Diagnosis 238
Pathogenesis 239
Treatment 239
Conclusions 241
References 241
CHAPTER 21 Microscopic Polyangiitis 243
Disease demographics and epidemiology 243
Clinical features 245
General symptoms 245
Renal involvement 245
Pulmonary involvement 246
Skin involvement 246
Gastrointestinal involvement 247
Neurologic involvement 247
Other organ involvement 247
Laboratory findings 247
Histopathology 249
Pathogenesis 250
Treatment 251
References 252
CHAPTER 22 Granulomatosis with Polyangiitis (Wegener’s) 254
Epidemiology and socioeconomic impact 254
Clinical features 255
General features 255
Ear, nose and throat features 256
Ocular features 256
Lower respiratory tract features 256
Nervous system 257
Musculoskeletal features 257
Skin 259
Glomerulonephritis 259
Pulmonary–renal presentation 260
Laboratory findings 261
Antineutrophil cytoplasmic antibodies 261
Histopathology 261
Pathogenesis 262
Treatment 263
What the patient can do 265
Treatments beyond active GPA (WG) 265
References 266
CHAPTER 23 Eosinophilic Granulomatosis with Polyangiitis (Churg–Strauss Syndrome) 268
Introduction and history 268
Epidemiology and predisposing factors 269
Clinical manifestations 270
Diagnostic investigations 271
Laboratory findings 271
Radiology 272
Histopathology 273
Synthesis of diagnostic data and differential diagnoses 274
Immunopathogenesis and patient subsets 274
Treatment 275
Conventional therapy 275
Outcomes 276
Experimental therapeutic approaches 276
Conclusions 277
Key concepts 277
Implications 277
Opportunities for future investigation 277
References 277
CHAPTER 24 Giant Cell Arteritis 279
Introduction 279
Epidemiology 279
Clinical features 280
Vascular giant cell arteritis 280
Extravascular giant cell arteritis 282
Diagnosis 282
Tissue diagnosis 283
Laboratory-based diagnostic tools 284
Imaging studies 284
Etiology and pathogenesis 285
Inherited factors 285
Noninherited factors 286
Innate immune responses 286
Adaptive immunity 287
Treatment 288
References 290
CHAPTER 25 Takayasu’s Arteritis 292
Introduction 292
Epidemiology 292
Disease manifestations 293
General 293
Regional differences 295
Diagnosis 296
Clinical findings 296
Serologic testing 296
Imaging studies 297
Histopathologic findings 298
Differential diagnoses 298
Pathogenesis 299
Treatment 299
Prevention of treatment-associated morbidity 301
Disease surveillance 302
Conclusions 302
References 303
CHAPTER 26 Behçet’s Syndrome 305
Epidemiology 305
Clinical manifestations 306
Mucocutaneous findings 306
Eye involvement 307
Musculoskeletal system involvement 307
Vascular and cardiac lesions 307
Central nervous system involvement 308
Gastrointestinal involvement 308
Other clinical features 308
Laboratory investigations 309
Imaging studies 309
Histopathology 309
Diagnosis and differential diagnosis 310
Pathogenesis 311
Treatment 311
Conclusions 313
References 313
CHAPTER 27 Cogan’s Syndrome 315
Demographics 315
Clinical and ancillary features 316
Synthesis of diagnostic data 319
Determining disease state (active vs. disease-induced damage) 322
Etiology and pathogenesis 323
Treatment 323
Eye 323
Vestibulo-auditory 324
Cardiovascular 325
Conclusions 326
References 326
CHAPTER 28 Idiopathic Cryoglobulinemic Vasculitis 328
Introduction 328
Demographic features 328
Epidemiology 328
Morbidity and mortality 329
Cryoglobulinemic vasculitis manifestations 329
Clinical features 329
Laboratory findings and test performance characteristics 331
Histologic features 332
Etiology 333
Physiopathology 334
Role of autoantibodies in cryoglobulinemic vasculitis 334
Involvement of cellular immunity 334
Treatment 335
Nonspecific immunosuppressive agents 335
B-cell depletion therapy 335
Type I cryoglobulinemic vasculitis 336
Conclusions 336
References 336
CHAPTER 29 Primary Central Nervous System Vasculitis 338
Introduction 338
Demographics and outcome 338
Clinical subsets and diagnostic features 339
Clinical and pathologic subsets 339
Laboratory findings 340
Synthesis of diagnostic data 343
Etiology and pathogenesis 345
Treatment 345
Conclusions 346
References 346
CHAPTER 30 Single Organ Vasculitis 348
Introduction 348
Histopathology and nosology in single organ vasculitis 349
Single organ vasculitis with diffuse involvement 349
Isolated vasculitis of calf muscles 350
Vasculitis limited to peripheral nerves 350
Isolated coronary and pulmonary arteritis 350
Retinal vasculitis 350
Focal single organ vasculitis 351
Breast vasculitis 351
Gynecologic vasculitis 351
Testicular vasculitis 352
Vasculitis involving abdominal territories 353
Isolated vasculitis of the aorta 354
Conclusions 356
Future perspectives 356
References 357
CHAPTER 31 Primary Cutaneous Vasculitis (Small Vessel Vasculitis) 359
Introduction 359
Clinical features 359
Laboratory findings 361
Histopathology 361
Diagnosis and differential diagnosis 362
Evaluation (Box 31.1) 362
Pathogenesis 363
Treatment 363
Standard approach 363
Experimental treatment 365
Conclusions 365
Key concepts and implications 365
Future investigations 365
References 365
CHAPTER 32 Buerger’s Disease (Thromboangiitis Obliterans) 367
Brief disease description 367
Demographics 367
Disability and mortality 368
Clinical and ancillary features 368
Laboratory findings 369
Imaging findings 369
Histopathology 370
Synthesis of diagnostic data 373
Differential diagnosis 373
Etiology and pathogenesis 374
Immunologically mediated injury to smoking 374
Endothelial dysfunction 374
Hypercoagulability 376
Genetic predisposition 376
Oral infection–inflammatory pathway 376
Treatment 376
Standard approaches 376
New treatment modalities under investigation 378
Conclusions 380
Acknowledgments 380
References 380
PART I I I Secondary Causes of Vasculitis 383
CHAPTER 33 Virus-Associated Vasculitides 385
Introduction 385
Hepatitis B virus 385
Small vessel vasculitis 385
Medium vessel vasculitis 385
Hepatitis C virus 387
Cryoglobulinemic vasculitis 387
Medium vessel vasculitis 389
Human immunodeficiency virus type 1 389
Clinical features 389
Pathogenesis 390
Treatment 390
Human T lymphotropic virus type 1 390
Varicella zoster virus 391
CNS vasculopathy 391
Retinal vasculitis 391
Other forms of vasculitis 392
Parvovirus 392
Small vessel vasculitis 392
Medium vessel vasculitis 392
Cytomegalovirus 392
Clinical findings 392
Laboratory findings 393
Histopathology 393
Treatment 393
Other viruses 393
Epstein–Barr virus 393
Herpes simplex viruses 1 and 2 393
Hepatitis A virus 393
Rubella 393
Conclusions 393
References 394
CHAPTER 34 Drug-Induced Vasculitis 396
Introduction 396
Classification 396
Epidemiology 396
Clinical features 398
Timing of clinical manifestations 398
Skin manifestations 398
Extracutaneous manifestations 399
Laboratory findings 399
Histopathology 399
Determining causality of specific drugs for vasculitis 400
Causal agents in drug-induced vasculitis 401
Antimicrobials 401
Vaccines 401
Hematopoietic growth factors 402
“Drugs of abuse” and related agents 402
Leukotriene inhibitors 403
Antirheumatic disease drugs 403
Drug-induced ANCA-positive vasculitis 403
Diagnosis 404
Tissue biopsy 404
Laboratory testing 404
Reporting adverse drug reactions 405
Management 405
Management of causative agents 405
Immunosuppressive therapy 405
Pathogenesis 406
Conclusions 406
References 406
CHAPTER 35 Rheumatoid Vasculitis 408
Introduction 408
Epidemiology and risk factors 408
Clinical manifestations 409
Skin 409
Peripheral nerves 410
Central nervous system 411
Ocular 411
Cardiac and aorta 412
Renal 412
Pulmonary 412
Gastrointestinal 412
Systemic manifestations 412
Drug-induced vasculitis in rheumatoid arthritis 413
Pathophysiology 413
Laboratory findings and diagnostic studies 414
Treatment 415
Traditional therapies 415
Biologic therapies 415
Prognosis and mortality 415
Conclusions 416
Key concepts that have been supported by multiple studies 416
Implications of these concepts 416
New opportunities for future investigation 416
References 416
CHAPTER 36 Systemic Sclerosis with Vascular Emphasis 419
Introduction 419
Prevalence 420
Associated conditions and methods of investigation 420
Epidemiology 421
Clinical features of vasculopathy in systemic sclerosis 421
Skin 421
Gastrointestinal system 422
Lung 422
Heart 423
Renal system 423
Laboratory diagnosis 423
Autoantibody determinations 423
Pathogenesis 424
Management 425
Prognosis 426
Progress in research into systemic sclerosis 426
Conclusions 427
References 427
CHAPTER 37 Vasculitis and Sj¨ogren’s Syndrome 428
Introduction 428
Epidemiology 428
Histology 429
Laboratory findings 429
Pathogenesis 430
Prognostic markers for developing vasculitis in SS patients 430
Clinical features 430
Skin 430
Peripheral and central nervous system 431
Other organs 432
Diagnosis 432
Vasculitis and mortality 432
Treatment 432
Conclusions 433
References 433
CHAPTER 38 Vasculitis in Systemic Lupus Erythematosus 435
Introduction 435
Demographics 435
Clinical features 436
Overall scope of disease manifestations in SLE 436
Manifestations of vasculitis in SLE 437
Diagnosis of lupus vasculitis 440
Laboratory testing 440
Histopathology 440
In vivo imaging 441
Synthesis of diagnostic data 442
Etiology and pathogenesis 444
Treatment 445
Standard approaches 445
Experimental approaches 445
References 447
CHAPTER 39 Vasculitis in the Idiopathic Inflammatory Myopathies 449
Introduction 449
Epidemiology 450
Clinical features (Table 39.1) 450
Cutaneous involvement 450
Gastrointestinal involvement 452
Pulmonary involvement 452
Other organ system involvement 453
Pathogenesis 453
Diagnosis and management 454
Conclusions 454
References 455
CHAPTER 40 Vasculitis and Relapsing Polychondritis 457
Introduction 457
Epidemiology 457
Clinical features 458
General clinical features 458
Vasculitic manifestations of RPC 459
Diagnosis 460
Laboratory findings 460
Imaging findings 461
Synthesis of diagnostic data 462
Evaluation of disease activity 463
Etiology and pathogenesis 463
Treatment and outcomes 464
Conclusions 464
References 465
CHAPTER 41 Systemic Vasculitis in Sarcoidosis 467
Introduction 467
Vasculitis in sarcoidosis 468
Small vessel vasculitis 469
Large and medium vessel vasculitis 470
Conclusions 473
References 474
CHAPTER 42 Vasculitis as a Paraneoplastic Syndrome and Direct Tumor Invasion of Vessels 476
Introduction 476
Epidemiology of paraneoplastic vasculitis and vasculitis associated with malignancies 476
Association of specific vasculitides with malignancies 479
Malignancies mimicking vasculitis 481
Vasculitis mimicking malignancy 482
Clinical manifestations of malignancy-associated vasculitis 482
Laboratory findings of malignancy-associated vasculitis 484
Histopathology 485
Synthesis of diagnostic and clinical data 485
Etiology and pathogenesis of malignancy-associated vasculitis 485
Treatment of malignancy-associated vasculitis 486
Conclusions 486
Acknowledgement 486
References 486
PART IV Recognizing Risks and Treating Damage from Vasculitis 489
CHAPTER 43 Cholesterol and Modifications of Cholesterol in Rheumatic Disorders 491
Introduction 491
Accelerated atherosclerosis in systemic autoimmune diseases 493
Lipid profiles in systemic autoimmune diseases 493
Lipid profiles during therapy 495
Oxidized LDL and autoimmunity to oxidized LDL in systemic autoimmune diseases 495
Therapy for accelerated atherosclerosis in systemic autoimmune diseases 495
Is statin use a risk factor for the development of systemic autoimmune diseases? 497
Conclusions 497
References 498
CHAPTER 44 Prevention and Treatment of Medical Complications 500
General medication toxicities 500
Infection 500
Immunizations 503
Malignancy 503
Effects on reproduction 504
Drug interactions 504
Medication-specific adverse effects 504
Glucocorticoids 505
Cyclophosphamide 506
Methotrexate 507
Azathioprine 508
Mycophenolate mofetil 508
Tumor necrosis factor inhibitors 508
Rituximab 508
Conclusions 509
References 509
CHAPTER 45 Ophthalmic Risks and Complications Associated with the Treatment of Systemic Vasculitis 511
Introduction 511
Ophthalmic history and examination 512
Therapeutic agents and ophthalmic implications 513
Corticosteroids 513
Antimetabolites (such as methotrexate, azathioprine and mycophenolate) 515
Alkylating agents (cyclophosphamide) 516
Biologic agents 518
Rituximab 518
Infliximab and other tumor necrosis factor inhibitors 518
Ocular complications of other medications used in patients with vasculitis 518
Bisphosphonates 518
Conclusions 519
Acknowledgments 519
References 519
CHAPTER 46 Subglottic Stenosis of Granulomatosis with Polyangiitis (Wegener’s) 521
Introduction 521
Etiology and pathophysiology 521
Clinical presentation 523
Diagnosis 524
Treatment options 524
Conclusions 526
References 526
CHAPTER 47 Sinonasal Manifestations of Granulomatosis with Polyangiitis (Wegener’s) 528
Introduction 528
Disease presentation and affected sites 528
Nasal and sinus disease manifestations 528
Otologic disease secondary to sinonasal GPA (WG) 529
Evaluation and diagnosis 529
Patient evaluation 529
Differential diagnosis 530
Management 531
Management of chronic rhinosinusitis in GPA (WG) 531
Nasal reconstruction for saddle-nose deformity 532
Management of chronic serous otitis media 534
Conclusions 535
References 535
CHAPTER 48 Neurologic Damage of Vasculitis 537
Introduction 537
Vasculitis of the peripheral nervous system 537
Anatomy of the nerve 537
Vulnerability of peripheral nerves to vasculitic neuropathy 537
Demographics and mortality and morbidity 540
Clinical diagnosis 540
Diagnostic findings 540
Assessing for damage 543
Treatment 543
Prognosis 543
Central nervous system damage 544
Mechanisms for motor recovery 544
Strategies for rehabilitation in CNS patients 544
Interventions to enhance motor recovery 544
Spasticity 545
Pharmacologic agents to enhance CNS recovery 545
Pain management 546
Rehabilitation 547
Appropriate utilization of rehabiltiation services 547
Conclusions 548
References 548
CHAPTER 49 End-Stage Renal Disease and Vasculitis 550
Introduction 550
Causes of ESRD in ANCA-associated vasculitis 550
End-stage renal disease in other forms of vasculitis 552
Henoch–Schönlein purpura 552
Cryoglobulinemia 552
Treatment and outcome of acute renal failure requiring dialysis in AAV 552
Disease course and outcome on chronic maintenance hemodialysis 554
Outcome after renal transplantation 556
Conclusions 557
References 557
CHAPTER 50 Cardiothoracic Surgery for Takayasu’s Arteritis and Giant Cell Arteritis 560
Takayasu’s arteritis 560
Coronary artery disease 560
Aortic aneurysms 562
Aortic regurgitation 565
Giant cell arteritis 567
Coronary artery disease 567
Aortic aneurysms 567
Aortic regurgitation 572
Conclusions 572
References 572
CHAPTER 51 Peripheral Vascular Surgery for Large Vessel Vasculitis 574
Introduction 574
Indications for surgical or endovascular therapy 574
Surgical treatment 575
Basic considerations 575
Site-specific considerations 577
Endovascular therapy 578
Basic considerations 578
Site-specific considerations 578
Outcomes 579
Conclusions 581
References 581
Index 583

Rezensionen

"This book provides a comprehensive overview of the
science and clinical consequences of vascular inflammation in
health and disease." (European Journal of
Immunology, 1 December 2012)

"Overall, this is an excellent source of information on
vasculitis for physicians at any level, including practicing
rheumatologists." (Doody's, 2 November
2012)

Produkt-Details

• Erscheint lt. Verlag: 4.4.2012
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Hämatologie
• Themenwelt: Studium ► Querschnittsbereiche ► Infektiologie / Immunologie
• Schlagworte: Blood vessels • Clinical Immunology • contributors • crivellato • David • dendritic • domenico • Enrico • Entzündung • Entzündung • Hämatologie • Hämatologie • Hematology • inflammation • Klinische Immunologie • Lawrence • List • Maria • mechanisms • Medical Science • Medizin • Morgan • Oxidative • Rheumatologie • rheumatology • Savage • Schaper • schmitzrixen • section • Segarra • Vascular
• ISBN-10: 1-118-35526-1 / 1118355261
• ISBN-13: 978-1-118-35526-8 / 9781118355268