By Yusuf (JP) Saleeby, MD (chief medical officer for Zimetry)
Published in American Fitness magazine (2015)
Vasculitis is an autoimmune disorder heralded by blood vessel involvement and inflammation. Blood vessels large and small, arteries, veins and capillaries can all be involved. The diseases are usually classified by the size of the blood vessels involved and/or the organs that are affected. There are several triggers and different regions of the body that can be affected. In general, inflammation develops in blood vessel walls which cause swelling, narrowing of the lumen and weakness of the structural wall. When swelling occurs there is usually pain and warmth of the vessel and surrounding areas. When there is narrowing, the blood flow through the artery or vein is compromised and distal organs can be affected. In the case of arteries, should there be drastic narrowing of the vessel lumen, there would be a reduction in blood flow. This reduction in blood flow carrying oxygen via red-blood-cells (RBC) may cause injury to tissue, known as ischemia. We see this with a particular type of vasculitis called Buerger’s disease, when fingers and distal extremities may autoamputate due to profound ischemia. When weakness of the vessel wall occurs, there can be a bulging or aneurysm formation of the affected location. When the aneurysm is of significant size, pooled blood can coagulate and form clots. This thrombotic state can raise the risk of distal thromboembolic phenomena that can cause injury to organs.
Inflammation plays a big role in vasculitis. Things get bad when organs are affected. End organs such as kidneys and lungs can be affected and those tissues can be destroyed.
There are different types of vasculitis and different end organs affected. For example when large vessels are involved you have conditions such as Behcet’s disease, which involve painful ulcers in the mouth and genital area with the uvia of the eyes often involved. It is usually specific to men in their 30’s and of Mediterranean descent. Another is Cogan’s syndrome which is more systemic and can lead to skin changes and eye inflammation and even hearing loss. Giant Cell arteritis occurs in the artery of the temple of our head and usually affects older folks. Headaches, scalp tenderness and pain are harbingers of this condition and without treatment can lead to sudden vision changes or loss.
Polymyalgia Rheumatica (PMR) affects the joints and muscles causing pain, stiffness and weakness, mostly of the proximal muscle groups of posture.
Medium sized vessels are affected in Raynaud’s phenomenon. Raynaud’s is a commonly seen malady where extremities such as fingers get cold and turn “white” with decreased blood flow when exposed to a trigger (like touching a cold object).
A rare childhood disease known as Kawasaki disease (KD) where the walls of vessels systemically are inflamed and all sizes are involved and can be damaged with aneurysms. Some serious cardiac issues may occur in these children if not treated early. It is successfully treated with medication if caught early and rarely do surgeons get involved to repair enlarged weak blood vessels.
Polyarteritis nodosa can present with lace like rash, bumps under the skin, anemia is yet another manifestation of a vasculitis. Wegener’s granulomatosis (GPA) is still another variety that affects the upper airway, lung and kidney. Signs and symptoms can include fever, loss of appetite, weight loss, fatigue and generalized pain. Very often there are skin manifestations. Organs involved can include skin, joints, the lung, the GI tract, upper airway system (nose & ears), eyes, the brain and nervous system tissue. It can be quite disturbing for a parent to find their child with a very high fever, mucous membrane lesions and peeling skin.
Tests that are used to diagnose vasculitis are measures of inflammation called a Sed Rate and C-reactive protein (CRP). Sometimes biopsy of an affected vessel is important as histologic evaluation can help make a diagnosis.
Treatments vary according to what type and the severity of the disease. Also considered in a medical regimen is what end organs are involved. Most treatment is by medication, but on occasion surgery is called for. Many can be treated with over-the-counter pain medications in the class called NSAIDs (Motrin, Aleve or aspirin). Other choices are corticosteroids like prednisone. Some physicians may prescribe cytotoxic medications. These types of medications will suppress our natural killer cells that cause inflammation. Some examples are cyclophosphamide, methotrexate and azathioprine. In pediatric cases of Kawasaki disease, high doses of aspirin are used in combination with intravenous immune globulin. To repair bulging vessels, vascular surgeons may have to go in and remove or repair aneurysms.
There are no set guidelines for prevention of vasculitis, however, keeping a healthy immune system, proper diet, avoiding environmental toxins and stimulants such as tobacco smoking and doing what it takes in higher risk patients to avoid triggers can help lower the risk of getting this disorder.
Natural Therapies Used to Treat Vasculitis
- Eat more fruits and vegetables (make sure that they are organically grown)
- Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, all foods (such as deep-fried foods) that might contain trans-fatty acids. Use extra-virgin olive oil as your main fat
- Increase your intake of omega-3 fatty acids. Take two to three grams of a molecularly distilled fish oil supplement each day
- Take anti-inflammatory herbs such as ginger and turmeric.
- Consider taking grape seed extract, a source of powerful antioxidant compounds called OPCs (oligomeric proanthocyanidins). Research has shown these compounds to be useful in protecting blood vessels, making them more elastic and less likely to leak.
- Garlic, Echinacea and Goldenseal are all excellent herbal treatments to boost the immune system. Garlic is particularly useful because of its anti-inflammatory and astringent properties. Echinacea should be limited to a few weeks.
- A major class of antioxidant compounds are flavonoids, which are found in berries, green tea, and citrus fruits.
Yusuf (JP) Saleeby, MD is an integrative functional medicine physician with a focus on age-management and hormone therapy. Utilizing advanced biomarkers in his practice he is able to predict risk of chronic illness and direct patients away from disease. Dr. Saleeby is an author and regular contributor to American Fitness magazine. He can be reached at firstname.lastname@example.org or www.Zimetry.com He has offices in Murrells Inlet, & Charleston, SC and Cary, NC.