Arteritis

When thinking about blood vessel problems, most people think about blood clots and hardening of the arteries. These are the most common causes of blood vessel "blockage." The medical term for hardening of the arteries, atherosclerosis, represents the most common reason why Americans die as they get older. Risk factors for atherosclerosis, including high blood pressure, diabetes, high cholesterol, and tobacco use, commonly play major roles in the development of artery blockage. Although much less common, there are artery problems that develop without atherosclerosis as the cause. One of these is known as "arteritis." Just by reading the name, you might be able to tell what it is: The arteries are inflamed (the "itis" in arteritis)!

Because arteritis is far less common compared to atherosclerosis, many doctors don't even consider this class of artery problems until it becomes quite advanced. Additionally, the cause of arteritis is generally unknown. So, patients with artery problems, particularly if they don't have the classic risk factors for atherosclerosis, need to be aware of the signs and symptoms of arteritis.

Besides being less common, the big challenge with arteritis is that arteries are found EVERYWHERE in the body–the heart, lungs, liver, kidneys, brain, arms, legs–you name it, wherever there is body tissue, there are arteries present. So, if you have a disorder that causes or results in inflammation of the arteries, any organ system in the body can have a problem.

Therefore, patients may visit the doctor with a broad array of problems—from skin rashes to joint and muscle pain, from headaches and seizures to high blood pressure, blood in the urine, asthma, and even jaundice. It is easy to see the challenges that doctors face, or why they might not think about artery inflammation when someone shows up with asthma! The diagnosis of arteritis can be made only if the doctor suspects this as a possibility. So, if someone visits the doctor with multiple problems involving different organ systems, and infection is not the cause, arteritis should be considered.

Diagnosis. The first tests ordered are often blood tests. These blood tests may demonstrate not only the presence of inflammation, but also underlying diseases that result in arteritis (such as systemic lupus erythematosis, scleroderma, and allergic reactions). Imaging tests, such as angiograms, which actually show pictures of the arteries, may be helpful. Sometimes small biopsies are performed, allowing the doctors to look at the artery walls under a powerful microscope to actually see the inflamed artery walls. Doctors classify arteritis depending on the size of arteries involved, and they often use different terms to identify the arteries involved or the disease process. Types of arteritis include polyarteritis nodosa, giant cell arteritis, cerebral arteritis, and Takayasu disease. Different-sized arteries can be affected–small, medium, and large. For example, Takayasu's disease typically affects large arteries such as the aorta and its major branches. Polyarteritis nodosa affects small arteries in the kidney, liver, and bowel. The treatment may differ depending on the size of the arteries involved and the underlying disease process.

Treatment is often with strong anti-inflammatory medications that shut down the inflammatory process. When used under the close supervision of an arteritis specialist (rheumatologist, vascular medicine specialist), these powerful medications can cure the problem. Unfortunately, many of these medications have serious side-effects. Your doctor will tell you about the risks and benefits of the proposed treatments.

All in all, the key is for the physician and patient to have a hunch about arteritis. Once the suspicion is made, the diagnosis and potential treatment may be right around the corner.

About the author: Michael R. Jaff, DO, FACP, FACC, is the director of the vascular diagnostic laboratory and vascular ultrasound core laboratory at Massachusetts General Hospital in Boston. He is pastpresident of the Society for Vascular Medicine and Biology and is a noted national speaker. He serves on the Board of Directors for the Vascular Disease Foundation.