Polyarteritis Nodosa

Question 1

What is polyarteritis nodosa?

Answer 1

1. Vasculitis (inflammation of the blood vessels)
   *necrotizing arteritis of medium/small sized vessels
   *type III HSN
2. Effects skin, peripheral nerves, mesenteric vessels, heart, and brain
   *watch out for stomach pain, especially 20-30 mins after eating
3. 10% is caused by hepatitis B

Question 2

What are the clinical findings of polyarteritis nodosa?

Answer 2

1. Insidious onset (feel like they’re developing a food allergy)
2. Fever, malaise, weight loss
3. Pain in extremities (arthralgia (joint pain), myalgia, or neuropathy)
4. Skin
   *livedo reticularis (lacy appearance, subcutaneous nodules, skin ulcers)
5. Abdominal pain (after eating)
6. Cholecystitis/appendicitis

Question 3

What are some of the CNS clinical findings of polyarteritis nodosa?

Answer 3

1. neuropathy
2. amaurosis fugax (temporary loss of vision)
3. peripheral neuropathy
4. Mononeuritis multiplex

Question 4

What are some laboratory findings of polyarteritis nodosa?

Answer 4

1. Mild anemia, leukocytosis (increase in WBC)
2. ESR/CRP may be significantly elevated
3. ANCA (anticytoplasmic autoantibodies) are negative
4. Low titers of Rf and ANA
5. Test for hepatitis B

Question 5

What are diagnostic tests for polyarteritis nodosa

Answer 5

1. Tissue biopsy
2. Angiogram

Question 6

What is the treatment of polyarteritis nodosa?

Answer 6

1. High dose corticosteroids (prednisone)
   *will control fever and constitutional sxs
   *will heal vascular lesions
   *40-60mg daily
2. Immunosuppressants
   *consider if severe and no response to prednisone
   *cyclophosphamide
3. Pulse methyprednisolone IV initially if critically ill
4. Plasmapheresis if HBV+ (and anti-HBV therapy)

Question 7

What is the prognosis of polyarteritis nodosa

Answer 7

1. 60-90% 5 yr survival w/ appropriate treatment
2. Poor prognosis if
   *kidney disease, proteinuria, GI ischemia, CNS disease, cardiac involvement