polyartiritis nodosum

Question 1

what is polyartiritis nodosum

Answer 1

• Blood vessel inflammation that causes injury to multiple organ systems
• systemic vascilitis
• necrosing inflammation of S+M arteries NOT ARTERIOLES
• transmural and segmental
• formation of microaneurysms - may rupture

Question 2

commonly affected sites

Answer 2

kidneys
skin
heart
peripheral nerves

Question 3

epidemiology

Answer 3

rare
M>F
40-60yrs
hep B

Question 4

associated with what condition

Answer 4

HepB

Question 5

aetiology

Answer 5

• primary / idiopathic
• secondary - hepB - due to immune complex deposition

Question 6

management

Answer 6

non-severe:
- oral corticosteroids with immunosuppressant (azathioprine / methotrexate)
- 2nd line - cyclophosphamide

severe PAN
- high dose oral corticosteroid
OR
pulsed IV steroids with cyclosphamide

Question 7

american college of rheumatology criteria

Answer 7

• weight loss
• myalgias, weakness / leg tenderness
• liverdo reticularis
• neuropathy
• testicular pain or tenderness
• diastolic BP>90
• elevated creatinine + BUN
• hep B
• arteriographic abnormaility
• artery biopsy

Question 8

severe symptoms

Answer 8

• mononeuritis multiplex (ischaemia of vasa nervosum)
• GI bleeds (mesenteric artery)
• CKD/AKI (renal artery)- causing pre renal AKI
• skin nodules + haemorrhage

Question 9

investigations

Answer 9

CT angiogram = looks like ‘beads on string’ (microaneurysms)

Biopsy (kidney) = necrotising vasculitis due to e.g htn