Yaseen Kinanah, Nevares Alana, Tamaki Hiromichi
Department of Rheumatic and Immunologic Diseases Cleveland Clinic, 9500 Euclid Avenue/A50, Cleveland, OH, 44195, USA.
Division of Rheumatology and Clinical Immunology and Robert Larner, MD, College of Medicine, University of Vermont Medical Center, Burlington, VT, USA.
Curr Rheumatol Rep. 2022 Nov;24(11):323-336. doi: 10.1007/s11926-022-01088-0. Epub 2022 Sep 21.
Drug-induced vasculitis (DIV) is a rare form of vasculitis related to the use of various drugs. DIV primarily affects small to medium size vessels, but it can potentially involve vessels of any size. Differentiating between primary systemic vasculitis and DIV can be challenging; however, it is crucial, so that the offending agent can be discontinued promptly.
The clinical phenotype of DIV is protean and depends on the size of the affected vessels. It ranges from arthralgias, to an isolated cutaneous rash, to severe single or multi-organ involvement. While withdrawal of the offending drug is the most important step in management, a significant number of patients require immunosuppressive therapy for varying periods of time. DIV can affect any vascular bed size, leading to protean vasculitic syndromes. Increased awareness among general practitioners, specialty, and subspecialty physicians is crucial for early recognition, and withdrawal of drug for better outcomes.
药物性血管炎(DIV)是一种与多种药物使用相关的罕见血管炎形式。DIV主要影响中小血管,但也可能累及任何大小的血管。区分原发性系统性血管炎和DIV可能具有挑战性;然而,这至关重要,以便能迅速停用致病药物。
DIV的临床表型多样,取决于受累血管的大小。其范围从关节痛到孤立的皮肤皮疹,再到严重的单一或多器官受累。虽然停用致病药物是治疗中最重要的步骤,但相当数量的患者需要在不同时间段接受免疫抑制治疗。DIV可影响任何血管床大小,导致多种血管炎综合征。提高全科医生、专科医生和亚专科医生的认识对于早期识别以及停用药物以获得更好的结果至关重要。