Polyarteritis nodosa (PAN) is a type of arterial disease known as vasculitis. It usually does not affect the small arteries, but is prevalent in medium-sized arteries of major organs. Therefore, almost all systems in the body are affected. It is a form of necrotizing vasculitis. Since the lungs are filled with capillaries (tiny blood vessels), these organs are usually not affected by PAN. On average, at least three people per 100,000 worldwide are known to have PAN. It is more often diagnosed in men than in women, but anyone at any age can be diagnosed with the disease. It is also associated with hepatitis B patients.
Diagnosis of PAN
A positive diagnosis of PAN is based on the person having at least three of the following signs and symptoms present. These include a positive hepatitis B test, weight loss greater than 6 kg (approximately 13 pounds), malaise, hypertension, arteritis, an increase in white blood cells in artery walls, increased creatinine/urea levels, testicular pain, and spider veins.
Signs and Symptoms of PAN
In terms of its signs and symptoms, PAN is actually difficult to diagnose. Imagine a disease that can produce signs or symptoms in all body systems. The most common presentation of the disease is vasculitis, or inflammation of the vessels. This condition is a necrotizing vasculitis that develops from ischemia, or lack of oxygen to the organs and tissues.
The most common symptoms are weakness, fatigue, headache, joint pain, and the occasional fever. As the disease progresses it can cause the following long-term conditions:
In the heart and circulatory system – a myocardial infarction (or heart attack), angina, or congestive heart failure. The person is prone to aneurysms.
In the gastrointestinal system – intestinal signs include nausea, vomiting, pain, and cholecystitis (gallbladder inflammation).
In the skin – PAN can cause skin ulcers, nodules, Raynaud’s phenomenon, spider veins (scientifically known as livedo reticularis).
In the central and peripheral nervous system – signs and symptoms of PAN in this system include arteritis, seizures, encephalopathy (brain swelling), and hemorrhage into the subarachnoid space.
In the renal system – the person diagnosed with this condition can develop renal failure or chronic hypertension.
Treatment of PAN
Treatment of polyarteritis nodosa involves the use of immunosuppressive drugs and corticosteroids. If the person becomes resistant to steroid use, then cyclophosphamide is used in some cases. In patients who have a positive hepatitis B test, an antiviral drug such as vidarabine can be used to manage the condition.
Complications of PAN
Serious complications of PAN include renal failure, heart attack, bowel infarction, pericarditis, and pancreatitis. If left untreated, polyarteritis nodosa is usually fatal, but if diagnosed early on, the survival rate is at least 80 percent.
Print Source: Davidson, Stanley & C. Haslett. 2002. "Davidson’s Principles and Practice of Medicine.” Churchill Livingstone, Edinburgh.
Print Source: Cotran R, Kumar V, and Robbins, SL. 1999. Robbins Pathologic Basis of Disease, 6th Ed. W.B. Saunders Company, Philadelphia.
Web Source: US National Library of Medicine & National Institutes of Health. "Polyarteritis Nodosa.” 2009. Available: https://www.nlm.nih.gov/medlineplus/ency/article/001438.htm