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Rzadkie przyczyny trudno gojących się ran: mikroskopowe zapalenie naczyń

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Mikroskopowe zapalenie naczyń (ang. microscopic polyangiitis, MPA) to zapalenie małych naczyń krwionośnych, w przebiegu którego dochodzi do wystąpienia zmian martwiczych w ścianach naczyń. MPA może stanowić jedną z rzadkich przyczyn trudno gojących się ran.

Przyczyny MPA

Mikroskopowe zapalenie naczyń zalicza się do grupy ANCA-dodatnich zapaleń naczyń. Do kategorii tej oprócz MPA należą również schorzenia takie jak ziarniniakowatość Wegenera czy zespół Churga-Strauss. U pacjentów cierpiących na ANCA-dodatnie zapalenia naczyń w surowicy występują przeciwciała skierowane przeciwko antygenowi cytoplazmatycznemu neutrofili i monocytów (ang. antinuclear cytoplasmic antibodies, ANCA). Przeciwciała te tworzą kompleksy immunologiczne, co przyczynia się do uszkadzania naczyń.

W przebiegu chorób z grupy ANCA-dodatnich zapaleń małych naczyń występują zapalenia ścian naczyń o charakterze martwiczym. Zmiany chorobowe mogą być obecne w wielu narządach.

MPA jako przyczyna trudno gojących się ran

ANCA-dodatnie zapalenia naczyń, w tym również mikroskopowe zapalenie naczyń, mogą powodować objawy skórne w postaci ran przewlekłych.

Za pojawienie się ran przewlekłych w przebiegu MPA mogą odpowiadać dwa mechanizmy chorobowe. Pierwszy to leukocytoklastyczne zapalenie naczyń krwionośnych żyłek pozawłosowatych, w niektórych przypadkach rozszerzające się na tętniczki i małe żyły. Klinicznie objawia się ono jako krwotoczne grudki, guzy i owrzodzenia. W przebiegu MPA może również wystąpić zapalenie naczyń małych tętnic lub tętniczek, które daje objawy w postaci plamicy uniesionej lub sinicy z wrzodziejącymi guzami.

Leczenie MPA

W terapii MPA, podobnie jak w przypadku innych ANCA-dodatnich zapaleń naczyń, stosuje się leki immunosupresyjne i glikokortykosteroidy. Celem leczenia jest uzyskanie remisji choroby. W okresie remisji u pacjenta kontynuuje się leczenie podtrzymujące.

Źródła:

Isoherranen K, Jordan O’Brien J, Barker J et al. EWMA document; Atypical wounds. Best clinical practice and challenges.

Bułło B., Rutkowski B., “ANCA-dodatnie zapalenia małych naczyń – współczesne aspekty terapeutyczne”, „Forum Nefrologiczne” 2012, 5 (1): 5-18.

Przeczytaj także: Co to jest rana i jak powinien przebiegać proces gojenia?

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