CV

Polyarteritis Nodosa

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Polyarteritis Nodosa

  • See Also
  1. Vasculitis
  • Epidemiology
  1. Prevalence: May approach 33 Million cases worldwide
  2. Gender: Slight male predominance
  3. Age: 30-40 years old
  • Classification
  1. ANCA negative Vasculitis
  2. Now differentiated from microscopic polyangitis
  • Pathophysiology
  1. Medium vessel Vasculitis involving muscular arteries
  2. Can affect any organ (esp. Kidney, skin, joint, Muscle, nerve, Intestine), but typically does not involve the lung
  3. Effects are related to vessel wall thickening, vessel narrowing and ultimately arterial Occlusion with secondary tissue infarction
  • Associated Conditions
  1. Hepatitis B Infection
  2. Hepatitis C Infection
  3. Hairy Cell Leukemia
  • Symptoms
  1. Fever
  2. Weight loss
  3. Hypertension
  4. Abdominal Pain
  5. Melena
  6. Peripheral neuritis
  • Signs
  • Skin
  1. Tender erythematous Nodules similar to Erythema Nodosum
  2. Palpable Purpura
  3. Livedo reticularis
  4. Skin Ulceration
  5. Vesicobullous lesions
  • Signs
  • Systemic
  1. Renal Insufficiency
  2. Hypertension
  3. Mononeuropathy Multiplex
  4. Neuropathy
  5. Myopathy
  6. Mesenteric arteritis
  7. Coronary ischemia
  • Labs
  1. Vasculitis labs (evaluate differential diagnosis)
  2. ANCA negative
  3. Serum Creatinine
  4. Creatinine Phosphokinase (CPK)
  5. Liver Function Tests
  6. Hepatitis B Surface Antigen
  7. Anti-Hepatitis C Antibody
  8. Urinalysis
  9. C-Reactive Protein (negative result would suggest alternative diagnosis)
  • Imaging
  1. Chest XRay (evaluate differential diagnosis)
  • Diagnosis
  1. Tissue Biopsy
  2. Imaging (CT Angiogram, MR Angiogram)
  • Differential Diagnosis
  1. See Vasculitis
  2. Infection
    1. Endocarditis
    2. Mycotic aneurysm
    3. Hepatitis B Infection
    4. Hepatitis C Infection
    5. HIV Infection
  3. Non-infectious causes
    1. Atypical thromboembolic conditions (e.g. atrial myoma, antiphospholipid Antibody syndrome)
    2. Fibromuscular dysplasia
  • Management
  1. Corticosteroids
  • References
  1. Merkel (2011) in UpToDate, Clinical features and diagnosis of Takayasu Arteritis, Accessed 11/30/11