Pediatric Vasculitis
Özet
Vasculitis refers to inflammation of blood vessels and is classified based on the affected vessel size. Diagnosing vasculitis in children is challenging due to the lack of a definitive laboratory test and its variable clinical presentation. Early diagnosis is crucial to prevent organ damage and improve prognosis. Small vessel vasculitis includes IgA vasculitis/Henoch-Schoenlein purpura, the most common type in children, affecting the skin, kidneys, and gastrointestinal system. ANCA-associated vasculitis often leads to kidney failure and pulmonary hemorrhage, with occasional cardiac involvement. Medium vessel vasculitis includes Kawasaki disease and Polyarteritis nodosa. KD is a leading cause of acquired heart disease in children, often resulting in coronary artery aneurysms. PAN can cause vascular occlusion, leading to hypertension and ischemic complications. Large vessel vasculitis, such as Takayasu arteritis, affects major arteries like the aorta and its branches, leading to hypertension, heart failure, and vascular stenosis. Diagnosis relies on laboratory tests, imaging, and biopsy. Treatment depends on the type and severity, including corticosteroids, immunosuppressants, and antithrombotic therapy. Long-term monitoring is essential to control inflammation and prevent cardiovascular complications. Timely identification and intervention improve prognosis by reducing inflammation; hence, the diagnostic concerned of patients exhibiting vasculitic symptoms requires special attention.
Vaskülit, damar enflamasyonudur ve etkilenen damar boyutuna göre sınıflandırılır. Çocuklarda vaskülit tanısı koymak, kesin bir laboratuvar testinin olmaması ve değişken klinik tablosu nedeniyle zordur. Erken tanı, organ hasarını önlemek ve prognozu iyileştirmek için çok önemlidir. Küçük damar vasküliti, çocuklarda en sık görülen ve cildi, böbrekleri ve gastrointestinal sistemi etkileyen IgA vasküliti/Henoch-Schoenlein purpurasını içerir. ANCA ile ilişkili vaskülitler sıklıkla böbrek yetmezliği ve akciğer kanamasına yol açar, nadiren kalp tutulumu da görülebilir. Orta damar vasküliti; Kawasaki hastalığı ve Poliarteritis nodozayı içerir. Kawasaki hastalığı çocuklarda edinsel kalp hastalığının önde gelen nedenlerinden biridir ve sıklıkla koroner arter anevrizmalarına yol açar. PAN damar tıkanıklığına neden olarak hipertansiyona ve iskemik komplikasyonlara yol açabilir. Takayasu arteriti gibi büyük damar vasküliti, aort ve dalları gibi büyük arterleri etkileyerek hipertansiyon, kalp yetmezliği ve vasküler stenoza yol açar. Tanı laboratuvar testleri, görüntüleme yöntemleri ve biyopsiye dayanır. Tedavi, kortikosteroidler, immünosupresanlar ve anti-trombotik tedavi dahil olmak üzere tipine ve şiddetine bağlıdır. Enflamasyonu kontrol etmek ve kardiyovasküler komplikasyonları önlemek için uzun süreli izlem şarttır. Zamanında teşhis ve müdahale, enflamasyonu azaltarak prognozu iyileştirir; bu nedenle, vaskülitik semptomlar gösteren hastaların tanısal şüphelenmede özel dikkat gerektirmektedir.
Referanslar
Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798-806.
Jayne D. The diagnosis of vasculitis. Best Practice & Research Clinical Rheumatology. 2009;23(3):445-53.
Sener S, Arslanoglu Aydin E, Batu ED. Cardiac involvement and cardiovascular risk factors in pediatric primary systemic vasculitides. Clin Rheumatol. 2023;42(3):673-86.
Mukhtyar C, Brogan P, Luqmani R. Cardiovascular involvement in primary systemic vasculitis. Best Pract Res Clin Rheumatol. 2009;23(3):419-28.
Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65(7):936-41.
Schnabel A, Hedrich CM. Childhood Vasculitis. Front Pediatr. 2018;6:421.
Falcini F, Cimaz R. Update on vasculitis in childhood. International Journal of Clinical Rheumatology. 2006;1(6):751.
Yılmaz N, Yüksel S, Becerir T, Girişgen İ, Ufuk F, Gürses D, et al. Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review. Clin Rheumatol. 2021;40(4):1635-44.
Kang Z, Wu W, Xun M, Ding Y, Li Z. Henoch-Schonlein Purpura /IgA Vasculitis Complicated by Coronary Artery Aneurysm: A Case Report and Literature Review. Front Pediatr. 2021;9:781106.
Misra DP, Shenoy SN. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. Rheumatol Int. 2017;37(1):151-67.
Zycinska K, Borowiec A. Cardiac manifestations in antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitides. Kardiol Pol. 2016;74(12):1470-6.
Theisen A, Phillips CL, Rodriguez M. ANCA-associated vasculitis with cardiac valve vegetations in two teenage males: two case reports and a literature review. Pediatr Rheumatol Online J. 2022;20(1):94.
Canares TL, Wahezi DM, Farooqi KM, Pass RH, Ilowite NT. Giant coronary artery aneurysms in juvenile polyarteritis nodosa: a case report. Pediatr Rheumatol Online J. 2012;10(1):1.
McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;135(17):e927-e99.
Maggio MC, Corsello G. Atypical and incomplete Kawasaki disease. Italian Journal of Pediatrics. 2015;41(Suppl 2):A45.
Zeng YY, Zhang M, Ko S, Chen F. An Update on Cardiovascular Risk Factors After Kawasaki Disease. Front Cardiovasc Med. 2021;8:671198.
Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation. 2006;113(22):2606-12.
Li T, Feng J, Li N, Liu T. Correct identification of incomplete Kawasaki disease. J Int Med Res. 2021;49(3):3000605211001712.
Zucker EJ, Chan FP. Pediatric cardiothoracic vasculitis: multimodality imaging review. Pediatr Radiol. 2022;52(10):1895-909.
Szugye HS, Zeft AS, Spalding SJ. Takayasu Arteritis in the pediatric population: a contemporary United States-based single center cohort. Pediatr Rheumatol Online J. 2014;12:21.
Sag E, Batu ED, Ozen S. Childhood systemic vasculitis. Best Pract Res Clin Rheumatol. 2017;31(4):558-75.
Yao X, Wang XN, Lai JM. Pediatric Behcet's disease with cardiac valvular lesions: A case-based review. Sci Prog. 2023;106(2):368504231173404.
Farouk H. Behcet's disease, echocardiographers, and cardiac surgeons: together is better. Echocardiography. 2014;31(6):783-7.
Farouk H, Zayed HS, El-Chilali K. Cardiac findings in patients with Behcet's disease: Facts and controversies. Anatol J Cardiol. 2016;16(7):529-33.
Granata C, Damasio MB, Zaottini F, Airaldi S, Malattia C, Colafati GS, et al. Imaging of Childhood Vasculitis. Radiol Clin North Am. 2017;55(5):1131-43.
Ozen S, Sonmez HE, Demir S. Pediatric forms of vasculitis. Best Pract Res Clin Rheumatol. 2018;32(1):137-47.
Seki M, Minami T. Kawasaki Disease: Pathology, Risks, and Management. Vasc Health Risk Manag. 2022;18:407-16.
Fukazawa R, Kobayashi J, Ayusawa M, Hamada H, Miura M, Mitani Y, et al. JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease. Circ J. 2020;84(8):1348-407.
Morishita K, Brown K, Cabral D. Pediatric vasculitis: advances in treatment. Curr Opin Rheumatol. 2015;27(5):493-9.
de Souza AW, Machado NP, Pereira VM, Arraes AE, Reis Neto ET, Mariz HA, et al. Antiplatelet therapy for the prevention of arterial ischemic events in takayasu arteritis. Circ J. 2010;74(6):1236-41.
Joseph G, Thomson VS, Attumalil TV, Mathen PG, Anandaraj AM, George OK, et al. Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis. J Am Coll Cardiol. 2023;81(1):49-64.
Godil SA, Saqi B, Godil K, Sabzwari SRA, Rajeswaran Y. Catastrophic Cardiac Complications of Takayasu's Arteritis. Cureus. 2020;12(7):e9142.
Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, et al. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord. 2021;21(1):7.
