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Guzkowe zapalenie tętnic – objawy skórne

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Guzkowe zapalenie tętnic, czyli martwicze zapalenie średnich i małych naczyń, może dotknąć wielu narządów. Zmiany wywołane tą chorobą może zaobserwować między innymi na skórze.

Etiologia i patogeneza guzkowego zapalenia tętnic

Przyczyny rozwoju tej choroby nie zostały poznane. Istnieje hipoteza o podłożu autoimmunologicznym guzkowego zapalenia tętnic.

W przebiegu guzkowego zapalenia tętnic dochodzi do wykształcenia procesu zapalnego przede wszystkim w średnich naczyniach tętniczych typu mięśniowego. Stanem zapalnym objęte zostają błona wewnętrzna, środkowa i przydanka. Skutkiem tego procesu jest wytworzenie nacieków zapalnych, zakrzepów i mikrotętniaków o skłonności do pękania. Światło naczyń zostaje zwężone lub zamknięte, co w konsekwencji prowadzi do niedokrwienia tkanek i narządów i rozwoju zmian o charakterze martwiczym.

Zmiany chorobowe mogą objąć wiele narządów jednocześnie.

Objawy guzkowego zapalenia tętnic

Na początkowym etapie rozwoju choroby występują niecharakterystyczne objawy ogólne – osłabienie, gorączka, częstsze odczuwanie zmęczenia, bóle stawów i mięśni, spadek masy ciała. W dalszym przebiegu choroby pojawiają się objawy narządowe związane z niedokrwieniem. Najczęściej dotyczą one nerek, wątroby, układu pokarmowego, układu nerwowego, jąder i najądrzy, trzustki i śledziony, a także skóry.

Zmiany skórne w przebiegu grudkowego zapalenia tętnic

Częstym objawem skórnym guzkowego zapalenia tętnic jest siność siateczkowata (livedo reticularis), czyli schorzenie przejawiające się w postaci czerwononiebieskich, tworzących siateczkę plam na skórze,które pod wpływem zimna stają się ciemniejsze i wyraźniejsze.

Inny obserwowany w przebiegu guzkowego zapalenia tętnic objaw to plamica uniesiona – rumieniowe plamy i guzki, które zlewają się w podskórne wybroczyny uniesione ponad zdrową skórę.

W związku z niedokrwieniem mogą wystąpić zmiany troficzne w postaci przebarwień, zmniejszenia grubości skóry, a także zmian rozpadowych. Następstwem tych procesów może być pojawienie się owrzodzeń w obrębie kończyn, przede wszystkim na częściach dystalnych. Zmiany wrzodowe goją się z pozostawieniem blizn.

W przypadku niewielkiego odsetka pacjentów w przebiegu choroby mogą wystąpić jedynie objawy ogólne i skórne, bez zajęcia narządów wewnętrznych. W tej grupie pacjentów przebieg choroby jest łagodniejszy. Obserwuje się lepszą responsywność na leczenie oraz większy odsetek pełnych wyleczeń.

Źródła: https://www.mp.pl/, https://www.przegladreumatologiczny.pl/, https://podyplomie.pl/

Przeczytaj także: „Medycyna to schody ruchome, które jadą w dół. Musimy walczyć, żeby się na nich utrzymać” – rozmowa z dr. n. med. Grzegorzem Krasowskim

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