Description A rare, but potenti...
Description
A rare, but potentially life-threatening, disorder that causes inflammation of small and medium sized arteries. Blood supply to affected organs is slowed and this results in damage. Polyarteritis nodosa most commonly affects kidneys, nerves of the arms and legs, and the abdominal organs (bowel, liver, pancreas). Less commonly, the skin, heart, eyes, muscles, brain and reproductive organs can be affected. The average age of onset is 45 years and men are affected twice as often as women. PAN can be associated with chronic hepatitis B infection.
Symptoms
Symptoms may include fever, a feeling of unease and weight loss. With multi-organ involvement, some patients experience joint aches, skin rash, high blood pressure, abdominal pain, nausea, vomiting, shortness of breath, and testicular pain. More serious systems may include chest pain, confusion, seizures and decreased urine output (kidney failure).
Tests
Common tests used for diagnosis and treatment
Workup:
A complete history and physical will be performed. Blood tests including a CBC, comprehensive metabolic panel (CMP), urine analysis, erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) will be performed. Imaging tests are often needed, such as CT scans and/or an MRI. Diagnosis is usually confirmed by biopsy of the skin, a nerve or other involved tissue.
Tests:
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Erythrocyte sedimentation rate (ESR), Hepatitis profile, Activated partial thromboplastin (aPTT or PTT), Prothrombin test (PT, INR), Urinalysis (UA), Anti-neutrophil cytoplasmic antibody (ANCA)
Other Specific Tests: CT scan, ultrasound, arteriography, MRI, tissue biopsy, 24-hr urine collection, EKG, troponin
Specialists:
Internal Medicine, Rheumatology, Family Practice
Workup:
A complete history and physical will be performed. Blood tests including a CBC, comprehensive metabolic panel (CMP), urine analysis, erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) will be performed. Imaging tests are often needed, such as CT scans and/or an MRI. Diagnosis is usually confirmed by biopsy of the skin, a nerve or other involved tissue.
Tests:
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Erythrocyte sedimentation rate (ESR), Hepatitis profile, Activated partial thromboplastin (aPTT or PTT), Prothrombin test (PT, INR), Urinalysis (UA), Anti-neutrophil cytoplasmic antibody (ANCA)
Other Specific Tests: CT scan, ultrasound, arteriography, MRI, tissue biopsy, 24-hr urine collection, EKG, troponin
Specialists:
Internal Medicine, Rheumatology, Family Practice
Treatment
Therapy depends on the severity of the symptoms and whether there is co-existent chronic hepatitis B infection. Mild cases may be treated with a corticosteroid such as prednisone. More severe cases with heart, nerve or kidney involvement may be treated with both prednisone and an additional immunosuppressant such as cyclophosphamide (Cytoxan, Neosar) or azathioprine (Imuran). Hepatitis B associated PAN is usually treated with antiviral agents, a corticosteroid and sometimes plasmapheresis.