Uveitis associated with polyarteritis nodosa

Introduction to uveitis associated with nodular polyarteritis Nodular polyarteritis is a rare disease characterized by necrotizing vasculitis involving multiple systems and multiple organs. It mainly involves small arteries and medium-sized arteries, and can also involve capillaries and veins. Occurs in women aged 20 to 40. Some patients have eye involvement, almost any eye tissue can be affected, such as conjunctival hyperemia, edema, subconjunctival hemorrhage, scleral inflammation, scleritis, ulcerative keratitis, uveitis, neuro-ophthalmological damage and eyelid involvement . basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: retinal vasculitis vasculitis

Causes of uveitis associated with nodular polyarteritis

(1) Causes of the disease

Not completely clear.

(two) pathogenesis

The pathogenesis of this disease is not fully understood. Some people believe that some viruses such as hepatitis B virus, human immunodeficiency virus, cytomegalovirus, hepatitis A and C viruses, and miniviruses may play a role in their occurrence. Role, these viruses can participate in the disease by inducing the expression of Fc receptors, C3B receptors of vascular endothelial IgG, promoting leukocyte adhesion, promoting the expression of MHC class II antigens in endothelial cells, and IL-1 production; It is believed that autoimmune responses to endothelial cells may also play a role in their development; current studies have also shown that it is a T cell mediated disease.

Uveitis prevention associated with nodular polyarteritis

1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.

Uveitis complications associated with nodular polyarteritis Complications retinal vasculitis vasculitis

Choroidal vasculitis and retinal vasculitis are the most common.

Nodular polyarteritis associated with uveitis symptoms Common symptoms Abdominal pain Eye pain Joint pain Conjunctival edema and corneal ulcer Nitrogenemia Subcutaneous nodules Scleral outer inflammation Hypertension Hairy reticular leukoplakia

1. Eyes showing 10% to 20% of patients with ocular involvement, almost any eye tissue can be affected, such as conjunctival congestion, edema, subconjunctival hemorrhage, Sjögren syndrome, scleral inflammation, scleritis, ulcer Keratitis, uveitis, neurological eye damage and eyelid involvement (Table 1).

(1) Scleral outer inflammation, scleritis and scleral keratitis: inflammation of the surface sclera, sclera and limbal vessels can cause scleral inflammation, scleritis and scleral keratitis, and keratitis with scleritis and peripheral corneal ulcer Common eye manifestations of this disease, patients often have severe eye pain, peripheral corneal ulcers continue to progress to the center of the cornea, severe cases can cause corneal perforation, scleral inflammation can be used as the initial manifestation of nodular polyarteritis, therefore, Patients with scleral laminitis should think about the possibility of this disease.

(2) uveitis: can be manifested as acute non-granulomatous iritis, vitreitis, non-granulomatous uveitis, choroidal vasculitis, retinal vasculitis, etc., these are caused by uveal or retinal vascular involvement .

2. Systemic manifestations of this disease can involve any tissue or organ, the most commonly affected are the skin, kidney, cardiovascular, gastrointestinal tract, muscle, bones, nervous system and eyes, systemic performance is usually non-specific, mainly fever, Headache, discomfort, weight loss, muscle pain, joint pain, testicular pain, etc.

(1) Skin lesions: 1/3 to 1/2 of patients have skin lesions, the most common are palpable purpura and subcutaneous nodules, subcutaneous nodules are distributed along the superficial arteries, these nodules are more common in Around the knee joint, the front lower limbs and the instep, there may be thrombosis, causing tissue infarction, especially in the fingers and toes, showing tender nodules, purpura or hemorrhagic bullae, severe cases can occur extensively Finger or toe cyanosis, in addition, patients may have lobular hemorrhage, reticular bluish and skin ulcers.

(2) Kidney damage: About 75% of patients have kidney damage, mainly characterized by hypertension, proteinuria and hematuria, often accompanied by mild to moderate azotemia, renal infarction or rupture of intrarenal aneurysm can cause sudden onset Abdominal pain, in severe cases can endanger the patient's life.

(3) cardiovascular changes: is a common systemic manifestations, manifested as hypertension, coronary thrombosis, pericarditis, pericardial hemorrhage, acute aortitis, arrhythmia, heart failure and so on.

(4) changes in the nervous system: motor and sensory neurological disorders, multiple mononeuritis, etc. may occur.

(5) Gastrointestinal changes: mesenteric, intestinal mucosa, submucosal vasculitis, infarction of the liver and spleen can cause abdominal pain, intestinal gangrene, peritonitis, intestinal perforation, intra-abdominal hemorrhage.

(6) Other systemic changes: non-erosive and non-deformable arthritis, muscle pain, epididymitis, etc. may occur.

Examination of uveitis associated with nodular polyarteritis

1. Blood tests may have the following abnormalities: 1 accelerated erythrocyte sedimentation rate; 2 neutropenia; 3 elevated serum globulin; 4 positive for hepatitis B antigen; 5 positive for condensed protein; 6 with circulating immune complex; Positive for granulocyte cytoplasmic antibodies.

2. Urine examination can occur hematuria, red blood cell cast, proteinuria and so on.

3. Histological examination found that necrotizing segmental vasculitis is helpful for diagnosis. Histological changes mainly include destruction of internal elastic membrane with fibroid deposition, neutrophil and monocyte infiltration of vessel wall, and later Can be a granuloma change.

4. Fluorescent fundus angiography and indocyanine green angiography can detect abnormal changes in the retina and choroidal vessels.

Diagnosis and differentiation of uveitis associated with nodular polyarteritis

The diagnosis of this disease is based primarily on typical clinical manifestations and histological examinations.

The disease should be differentiated from some diseases with systemic vasculitis such as Behcet's disease, systemic lupus erythematosus, mixed connective tissue disease, progressive systemic sclerosis, dermatomyositis, etc.; the uveitis caused by it should be compared with other diseases Causes of non-granulomatous uveitis such as acute anterior uveitis associated with ankylosing spondylitis, HLA-B27 antigen-positive acute anterior uveitis, Behcet's disease uveitis, sarcoma-like uveal Inflammation, idiopathic retinal vasculitis, tuberculous uveitis, syphilitic uveitis and other phases.

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