Polyarteritis Nodosa

Question 1

what is polyarteritis nodosa?

Answer 1

necrotising inflammation of medium sized arteries without glomerulonephritis/vasculitis in arterioles, venules, capillaries

aneurysms lead to thrombosis and infarction

Question 2

cause of HBV-related polyarteritis nodosa

Answer 2

deposition of immune complexes -> activate complement cascade -> inflammation -> vessel wall damage

vasculitis occurs within first few months of infeciton

Question 3

who is polyarteritis nodosa usually seen in

Answer 3

middle-aged men

Question 4

presentation of polyarteritis nodosa?

Answer 4

systemic vasculitic features + hep b signs
NO PULMONARY SYMPTOMS

skin (purpura, rash, punched out ulcers, nodules)
renal (artery narrowing, ischaemia, HTN, haematuria)
cardio
GI (abdo pain, melena, jaundice/pruritus due to obstructive hepatic impairment due to hep b)
livedo reticularis

Question 5

where is livedo reticularis also seen other than polyarteritis nodosa?

Answer 5

antiphospholipid syndrome

Question 6

ix of polyarteritis nodosa

Answer 6

fbc - elevated wcc
hbv serology - possible hbsag +
esr/crp - elevated
mra - string of pearls appearance (microaneurysms and spasm)
renal biopsy - focal transmural inflammation and fibrinoid necrosis

Question 7

mx of polyarteritis nodosa

Answer 7

prednisolone
if severe, add DMARD

Question 8

comps of polyarteritis nodosa

Answer 8

corticosteroid side effects
renal failure
GI complications from ischaemia