Polyarteritis Nodosa
Polyarteritis nodosa causes sections of the middle and outer layers of a blood vessel to swell and become inflamed. Eventually, the tissues of the vessel die. This most commonly occurs where a blood vessel branches into two or more vessels. The inflammation usually begins in the middle layer of medium-sized blood vessel and spreads to the outer and inner layers.
The inflammation and damage to the vessels can lead to the development of blood clots that can block the flow of blood through the artery, damaging organs and tissues. Damage to the blood vessel walls can also cause weak spots (aneurysms) that bulge from the pressure of the blood through the vessel and are at risk of bursting open. When the damaged areas heal, the blood vessel may be left with fibrous nodes in the outer wall of the vessel.
Symptoms of Polyarteritis Nodosa
Polyarteritis nodosa mimics many diseases. Polyarteritis nodosa may be similar to hypersensitivity angitis, Churg-Strauss syndrome, Cogan's syndrome, Kawasaki's disease and complications associated with methamphetamine addiction, hepatitis B and C infections and other liver conditions.
The symptoms can vary widely. The disease may be acute with a fever and on-going for a long time; milder but fatal within several months; or appear as a chronic, debilitating disease.
Specific symptoms vary depending on where the affected areas of the arteries are, how severe they are, how much of the blood circulation they affect and what the impact is on various organs.
The most common symptoms are:
Blood in the urine
Fever
High blood pressure
High levels of protein in the urine
Numbness, tingling or weakness of the hands and feet
Pain in the joints, especially the large ones
Skin rash with raised reddish-purple patches and knobs that can be felt along affected arteries
Stomach pain sometimes with nausea, vomiting and bloody diarrhea
Swelling
Weakness
Weight loss
The vessels of the kidneys, liver, heart, stomach and intestines are most often affected.
Causes and Risk Factors for Polyarteritis Nodosa
Currently, it is not known what causes polyarteritis nodosa. Various factors may be involved, including the body's defense or immune systems. Other factors include reactions to drugs such as penicillin, iodide and others; vaccinations; bacteria infections; and viral infections such as hepatitis, influenza and HIV.
While the disease can affect people of any age, it usually first appears in people between the ages of 40 and 50.
Diagnosing Polyarteritis Nodosa
A doctor may suspect polyarteritis nodosa when a patient has unexplained fever, stomach pain, kidney failure or high blood pressure. The condition may also be suspected if a patient with nephritis or a heart condition has unexplained joint pain, muscle tenderness or weakness, nodes beneath the skin, purplish skin rashes, pain in the stomach, hands or feet or high blood pressure that develops suddenly.
A doctor will rule out other causes of a fever or a condition that affects more than one system of the body at a time. There is no specific test that can be done to confirm polyarteritis nodosa. A doctor will base his or her diagnosis on the symptoms and tests such as:
A blood test
A urine test
Taking a sample of an artery lesion, nearby skin, muscles or nerves (a biopsy) for examination under a microscope
Angiography that shows aneurysms on medium-sized blood vessels in the kidneys, liver and stomach region
Electromyography, which measures the electrical impulses between nerves and muscles. This can help select a place for a biopsy.
Treating Polyarteritis Nodosa
If the condition is acute or chronic, it is usually fatal without treatment. The condition often causes failure of the heart, kidneys or other vital organisms or a ruptured aneurysm.
Treatment may include:
Eliminating drugs that may be causing reactions
Using high-dose corticosteroids to prevent the condition from becoming worse. This can partly or completely make the condition go away for about one out of three patients with polyarteritis nodosa. The dosage has to be carefully balanced against side effects such as high blood pressure. This is especially so when a patient already has kidney damage. The dosage given is usually lowered as symptoms improve.
Drugs that suppress the body's defense or immune system. These may be used alone or with corticosteroids
Measures to address specific problems such as high blood pressure, fluid retention, etc.
Surgery, which may be needed if there are intestinal or bowel complications
Lupus
According to the Centers for Disease Control and Prevention, more than 1.4 million Americans are affected by lupus (systemic lupus erythematosus). Lupus is a disease in which the body's own defenses are turned against themselves. The disease attacks the body by mobilizing antibodies and cells against the body's tissues. It affects the joints, muscles and other parts of the body. Sometimes the kidney, heart and brain are affected. 
With medical treatment and good management, people with lupus can lead active, healthy lives, but without treatment, complications from lupus can be life-threatening.
Symptoms
Symptoms vary from person to person and even with the same person from time to time. The most common signs are:
- A butterfly-shaped rash across the bridge of the nose and cheeks or a scaly, disk-shaped rash on the face, neck or chest
- Sensitivity to sunlight. People with lupus often experience severe rashes or sunburns after only a little time in the sun.
- Skin ulcers, usually painless, on the tongue or inside the mouth or nose
- Arthritis. Persons with the condition may experience joint pain, stiffness and swelling.
- Inflammation of the linings of organs such as the heart and lungs (serositis) that makes breathing painful or causes shortness of breath or chest pain.
- Kidney problems, such as inflammation, either without symptoms or accompanied by swelling of the legs, and high blood pressure.
- Brain or spinal cord problems, accompanied by headaches, seizures or mental problems.
A person may also experience:
- Fatigue along with dizziness, headaches or depression
- Unexplained fever, which may be an early sign of lupus
- Raynaud's phenomenon, in which fingers, toes, nose and ears turn pale and numb when exposed to cold
- Chest pain that may be accompanied by coughing
- Swelling of glands, legs or the area around the eyes
- Digestive problems, including loss of appetite, nausea, diarrhea and weight loss
- Unusual hair loss.
- Depression or trouble concentrating. This is either a result of the disease or a reaction to living with a chronic disease.
If lupus is not treated or controlled, these complications can result:
- Inflamed kidneys, which may cause no pain but can be detected with urine and blood tests. A blood test is used to check kidney function.
- Central nervous system problems, such as headaches, dizziness, difficulty concentrating, mood swings or seizures
- Blood and blood vessel problems. These include anemia, increased risk of bleeding, increased risk of blood clots or inflamed blood vessels.
- Inflammation of the lungs and the linings of the chest cavity. This can make breathing painful and increase the risk of a form of pneumonia.
- Chest pain resulting from inflammation of the heart muscle, arteries or heart membrane. The leading cause of death for people with lupus today is cardiovascular disease, which can lead to heart attacks. It is not clear whether this is because people with lupus are living longer or whether it is a complication of treatment. Exercising, not smoking, controlling high blood pressure and reducing cholesterol levels all help reduce the risk of cardiovascular disease.
- Infection, from having the disease and from treatment
- Tissue death, caused when the blood supply to certain areas is reduced. The hip joint is commonly affected and may result in pain when walking.
For women who are of the age to bear children, lupus creates special risks, including:
- Difficulty conceiving. Flare-ups of the disease and medications used to treat it can contribute to infertility.
- Greater risk for miscarriage. The risk is highest early or late in the pregnancy. The risk can be reduced by careful planning and medical care.
- More risk of complications during pregnancy. Flare-ups are more likely. The risk for high blood pressure, diabetes and kidney problems during pregnancy is also higher.
- Limited birth control options. Women may not tolerate birth control pills well, and they should not use intrauterine devices because of the risk of infection.
Causes and Risk Factors
The exact cause of lupus is unknown. Many doctors believe that a combination of factors (including genetic heritage, the environment and hormones) leads to its development. While lupus itself is not inherited, it is possible that some combinations of genes make a person more likely to develop the condition. A virus or bacterial infection may then cause the disease to develop.
Although anyone can develop lupus at any age, it mostly affects women in the childbearing years. Common risk factors include:
- Gender. Women are about nine times more likely than men to develop lupus.
- Race. African Americans are three to four times more likely than Caucasians to develop the disease.
- Family history. Having a relative who has lupus increases the odds.
- Pregnancy. Lupus sometimes shows up for the first time during pregnancy or shortly after giving birth.
Diagnosis
Lupus is often hard to diagnose because symptoms vary from person to person. Symptoms in an individual can vary over time. The doctor may not suspect the disease until symptoms become more obvious. Nearly all people with lupus have flare-ups and times when the disease goes away.
Diagnosis and treatment have improved a great deal in the past fifty years. Although the disease is not curable, there are many options for managing it. Certain criteria are helpful in diagnosing lupus, including: 
- Rash
- Sensitivity to sunlight
- Ulcers
- Arthritis
- Inflamed membranes
- Kidney problems
- Neurological problems, such as seizures or psychosis
- Blood problems, such as anemia
- Signs of immune problems
Physicians can use a variety of tests to diagnose lupus, including:
- Medical history and physical exam
- Blood test to get a complete blood count, to measure hemoglobin, red blood cells, white blood cells and platelets. Results may indicate anemia, which often occurs in lupus. Low white blood cell counts may occur as well.
- A blood test to see how fast red blood cells settle to the bottom of a test tube. If the blood sinks fast, this can indicate lupus or other inflammatory conditions or infection.
- A blood test to see how well the kidneys and liver are working
- Urinanalysis. This may show abnormal levels of protein or blood cells.
- Antibody testing. When antibodies are present, they can indicate an immune system problem.
- Chest X-rays can show lung problems that may be a sign of lupus
- ECG test, to test the heart's electrical system
- Syphilis test. This has nothing to do with checking for venereal disease.
Treatment
There is currently no cure for lupus, but treatment can ease symptoms and reduce complications. How lupus is treated depends on how seriously organs are affected. Because lupus may take many forms, finding the best treatment may take time and should be customized to the patient's needs.
The doctor may recommend a variety of medications, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may reduce joint and other tissue inflammation
- Antimalaria drugs. No one knows why these drugs help improve lupus. They may be useful for treating skin and joint problems and the inflamed surface of organs like the heart and lungs. These drugs may also prevent flare-ups of the disease.
- Immunosuppressive medications, which reduce normal immune responses. These may be prescribed if lupus is widely affecting organs, especially the kidneys. Immunosuppressive medications may cause anemia and a low white blood cell count. They may also increase risk of infection and cancer. The doctor may prescribe them if corticosteroids are not effective or to allow for a lower dose of corticosteroids to reduce side effects. Sometimes, even with drugs, the kidneys may fail, and a kidney dialysis or kidney transplant may be needed.
Lupus may not be a major illness, or it can be a serious, life-threatening one. The following precautions should be followed:
- Know the symptoms. Recognize when they are worse, and treat them. This can reduce the chance of permanent tissue or organ damage. Early treatment can cut the time spent taking higher doses of medications that cause side effects.
- Work with the doctor, and take medications only as directed
- Avoid exposure to the sun. Wear hats, long-sleeved shirts and long pants to avoid being in ultraviolet light and avoid a flare-up. Use sunscreens with a sun protection factor (SPF) of at least 15. Stay out of the sun during its strongest hours - 10 a.m. to 3 p.m.
Because lupus is a systemic problem, patients can best manage the disease by generally taking care of themselves. To improve the function of the immune system, patients need to:
- Get enough rest
- Exercise regularly
- Not smoke. Smoking increases the risk of cardiovascular disease and makes the effects of lupus worse on the heart and blood vessels.
- Limit alcohol use, which can affect the liver, kidneys, heart and muscles. Alcohol may also interact with medications.
- Eat a healthy, balanced diet
- Seek medical counseling when considering getting pregnant to find out steps that can be taken to ensure a safe pregnancy. This can reduce risks for the mother and the baby.
- Reduce stress and use relaxation methods, such as meditation or yoga
- Build a support network through family, friends or an organized support group
Lymphoma is one of the most common causes of death from cancer in the United States, and about 48,000 new cases of lymphoma are diagnosed every year. In lymphoma, cancer cells are found in the lymphatic system, which is comprised of the bone marrow, lymph nodes, spleen, stomach, intestines and skin. Because lymph tissues are present in many parts of the body, lymphoma can start almost anywhere.
Normal lymph nodes are tiny, bean-like structures that trap cells containing poisons and waste materials. They also serve as a reservoir of cells that supply microorganism-fighting antibodies. Tube-like vessels carrying milk-colored fluid called lymph connect lymph nodes to each other. Lymph allows white blood cells (lymphocytes) to circulate. When white blood cells multiply abnormally, they cause masses to form and lymph nodes become enlarged. Some lymphomas may affect the bone marrow and interfere with its making of blood cells. The result is anemia, or low red blood cell count.
Lymphomas are graded as low, intermediate and high depending on the kind of lymphoma cells present and how they affect lymph nodes and chromosomes. Some lymphomas grow faster and require specific treatment. Classifying them is complex because many kinds of lymphocyte cells can be involved.
These grow so slowly that patients can live for many years mostly without symptoms, although some may experience pain from an enlarged lymph gland. After five to 10 years, low-grade disorders begin to progress rapidly to become aggressive or high-grade and produce more severe symptoms.
This type progresses fairly rapidly without treatment. With treatment, remission can be induced in between 50 to 75% of cases. Initial treatment has been so successful that people who stay in remission for three years after diagnosis are often considered cured. Stage I disorders are treated with radiotherapy.
Without treatment, these can progress rapidly regardless of stage. They are treated aggressively. With treatment, between 50 to 75% of patients enter remission. Those who stay in remission one year can look forward to a life free from recurrence. Treatment consists of intensive combination chemotherapy, which is sometimes supplemented with radiation therapy. Drug regimens used are determined by a number of factors, the most important being tissue study.
Based on the course of disease and the kind of lymphocytes affected, lymphomas are divided into two types: Hodgkin's disease and non-Hodgkin's lymphoma.
About 75% of those diagnosed with Hodgkin's disease recover fully. About 90% of all people diagnosed with early-stage illness and more than 50% of those with more advanced stage are now living longer than 10 years with no signs of the disease coming back. The stage of the disease at diagnosis is critical in planning treatments. Sometimes giving the patient aggressive chemotherapy and then introducing young cells from the bone marrow (bone marrow transplantation) may increase chances of the patient living longer. A bone marrow transplant should be considered for every patient whose disease comes back after undergoing chemotherapy.
In the last 10 years, this disease has become easier to treat as more procedures are found to be effective. Overall, 50 to 60% of patients with NHL now live five years or longer without a recurrence. While a number of factors determine the best treatment for these disorders, the most significant is tissue classification followed by determination of the disease's stage.
In most cases, patients consult their doctors if they have painless swelling in the neck, armpits, groin or abdomen. Sometimes the swelling or the tumor occur in other organs, such as the skin or stomach (extranodal lymphoma) either as a first symptom or a sign appearing later in the disease. Like most cancers, lymphoma is best treated when found early. Symptoms are:
- Loss of appetite
- Loss of weight, nausea, vomiting, indigestion or pain in the abdomen
- A feeling of bloating
- Itching, bone pain, headaches, constant coughing and abnormal pressure and congestion in the face, neck and upper chest
- Fatigue and flu-like body aches
- Fatigue resulting from anemia
- Night sweats, recurring high-grade fever or constant low-grade fever
The cause of lymphoma is still not known, but it is not considered hereditary. Most lymphomas occur between the ages of 40 and 70 years. Hodgkin's disease, considered the most curable form of lymphoma, often occurs in young adults or the elderly. Possible triggers for lymphoma include:
- Genetic factors
- Certain infections or environmental factors
- Exposure to herbicides and high doses of radiation (including aggressive radiation therapy)
- Certain viruses (human retroviruses like HTLV-1 and to some extent, the Epstein-Barr virus are also suspected)
- AIDS (acquired immunodeficiency syndrome). These patients require specialized treatment.
- Abnormalities in the genetic materials called chromosomes and the body's immune response
- Although the disease has been reported in patients who live or work physically close to each other (clustering), no evidence exists that indicate the disease is infectious
In reaching a diagnosis of lymphoma, doctors may do the following:
- Take the patient's medical history
- Conduct a thorough physical examination to detect an enlarged lymph node, liver and/or spleen
- Order blood tests to check kidney and liver functioning
- Do a biopsy by removing a small amount of tissue from the suspected area and examining it to see the type of lymphoma present
Radiotherapy is the preferred treatment for patients with stage I or II lymphomas because it successfully induces long-term remissions and even cures in many cases. For treatment of stage III or IV low-grade disorders, one school of thought is to start intensive therapy right after diagnosis - whether a patient has symptoms or not - to achieve and maintain complete remission. Treatment usually consists of high-dose radiotherapy, chemotherapy or a combination of both. Intensive treatment involves risk, but recent studies suggest that such treatment may induce high rates of remission.
Bone marrow transplant is currently being studied as a treatment option for low-grade lymphoma.
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