Vasculitides - Polyarteritis Nodosa

Question 1

Define polyarteritis nodosa.

Answer 1

Polyarteritis nodosa (PAN) is a rare disease that results from blood vessel inflammation (“vasculitis”) causing injury to organ systems. The areas most commonly affected by PAN include the nerves, intestinal tract, heart, and joints.

Question 2

Explain the aetiology/risk factors of polyarteritis nodosa.

Answer 2

Hepatitis B virus (HBV) infection
Age 40 to 60 years

Question 3

Summarise the epidemiology of polyarteritis nodosa.

Answer 3

Over time, polyarteritis nodosa (PAN) has become progressively less common, largely owing to effective hepatitis B virus (HBV) immunisation programmes and improved blood screening for HBV, as well as to major alterations in the definition and classification of vasculitis.

Question 4

Recognise the presenting symptoms of polyarteritis nodosa. Recognise the signs of polyarteritis nodosa on physical examination.

Answer 4

Age 40 to 60 years
Fever
Weight loss
Myalgia or arthralgia
Mononeuritis multiplex
Paraesthesia
Muscle tenderness
Abdominal pain
Skin manifestations
Diastolic blood pressure >90 mmHg

Question 5

Identify appropriate investigations for polyarteritis nodosa and interpret the results.

Answer 5

CRP
ESR
FBC
Complement
Serum creatinine
Midstream urine analysis
Liver function tests
HBV serology
Hepatitis C virus (HCV) serology
ANCA, ANA, Anti-DSDNA