Polyarteritis Nodosa

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Polyarteritis Nodosa

  • necrotising vasculitis
  • males 4:1 woman
  • some associated with HBsAg
  • causes aneurysms of medium size arteries

Presentation

  • General
    • fever
    • malaise
    • weight loss
    • arthralgia
  • Renal (75%)
    • main cause of death
    • hypertension
    • haematuria
    • proteinuria
    • renal failure
    • intra-renal aneurysms
    • vasculitis
  • Cardiac (80%)
    • 2nd biggest cause of death
    • coronary arteritis and consequent infarction
    • hypertension
    • heart failure
    • pericariditis
  • Pulmonary
    • (Churg-Strauss syndrome)
  • CNS (70%)
    • mononeuritis multiplex
    • sensorimotor polyneuropathy
    • seizures
    • hemiplegia
    • psychoses
  • GI (70%)
    • abdominal pain
    • malabsorption
  • skin
    • urticaria
    • purpura
    • infarcts
    • livedo reticularis
    • nodules
  • blood
    • raised WCC
    • eosinophilia
    • anaemia
    • raised ESR/CRP
    • anaemia

Variants

Investigations

  • renal or mesentric angiography
  • ANCA may be positive

Treatment

  • meticulous control of BP
  • high dose prednisolone
  • cyclophosphamide
 

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