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Polyarteritis Nodosa

more about Polyarteritis Nodosa

PAN, Panarteritis, periarteritis nodosa, or Necrotizing Arteritis

  • In this condition (PAN), the medium and small arteries that carry blood to the organs of the body become swollen and damaged (inflammation).
  • PAN is classified as an autoimmune disease in which the body's own defenses (white blood cells, Proteins, or antibodies) attack the arteries in the organs.
  • Complications of PAN involve damage to other organs including the skin, kidneys, gut or GI tract, joints, muscles, heart, nerves, brain, testes, and ovaries.  The lungs are rarely affected.

  • Unknown, but autoimmunity is suspected

  • General symptoms:
    1. Fever
    2. Fatigue
    3. Headache
    4. Muscle aches (myalgia)
    5. Joint aches (arthralgia)
    6. Weight loss
  • Skin:
    1. Rash
    2. Bleeding under the skin
    3. Lumps -- nodes
  • Musculoskeletal:
    1. Muscle aches
    2. Joint aches
  • Kidney:
    1. High Blood Pressure
    2. Headache
    3. Pinkish urine -- Hematuria or Blood in the Urine
    4. Fatigue
    5. Weakness
  • GI:
    1. Abdominal pain
    2. Nausea
    3. Vomiting
    4. Bleeding -- vomiting blood, bloody stool
  • Heart:
    1. Shortness of breath
    2. Swelling of ankles
    3. Heart attack
    4. Fatigue
    5. High Blood Pressure
  • Nervous system -- brain and nerves:
    1. Seizures
    2. Stroke
    3. Numbness
    4. Confusion
    5. Headache
  • Other:
    1. Blood clots
    2. Lung problems -- cough, shortness of breath, coughing up blood (hemoptysis)
    3. Pain in the testes
    4. Pain in the lower part of the abdomen over the ovaries

  • History:
    1. Symptoms
    2. Illnesses
    3. Surgeries
    4. Medications
    5. Allergies
    6. Habits
    7. Occupation
  • Medical exam:
    1. May reveal lumps or nodes
    2. Livedo reticularis is a purplish discoloration over the skin of arms, legs, or torso.
    3. Blood pressure is elevated(>90mm Hg)
    4. Weight loss may be present(>4 Kg.)
    5. Muscle weakness or wasting may be present.
    6. Ankle swelling may be seen.
    7. Heart and lung sounds may be abnormal or diminished.
    8. There may be areas of numbness in the skin.
    9. Testicles may be painful or tender.
    10. Abdominal tenderness may be present.
  • Tests:
    • Blood:
      1. Elevated number of white blood cells especially neutrophils or eosinophils
      2. Elevated ESR and C-reactive proteins
      3. Elevated levels of antibodies (e.g., IgM)
      4. Presence of Hepatitis B antigen (sign of possible PAN infection)
      5. Anemia or low hemoglobin or low blood
      6. Abnormal liver and kidney functions
    • Urine:
      1. Red blood cells.
      2. Chest X-Ray will show round scars (areas of inflammation) known as granulomas in the lungs.
      3. Biopsy -- done by taking a sample of the damaged tissue.
      4. The piece biopsied will show inflammation of the small and medium arteries.
      5. Angiogram -- done by injecting a dye into the arteries, then taking a Radiograph (X-Ray).  The angiogram will show the segments of the artery affected by PAN.

  • There may be an association with Hepatitis B virus infection.
  • Male > female
  • Average age of incidence around 45

  • Depends on the degree of disease and organs involved
  • Low salt diet for High Blood Pressure
  • Dialysis (machine that filters the blood) for kidney failure
  • Medications such as Prednisone or Cyclophosphamide will decrease inflammation of the arteries.
  • Plasmopheresis -- filters the blood and removes harmful antibodies.
  • Consider Hepatitis B vaccine

  • Contact your doctor.  PAN may be fatal if left untreated.

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