Polyarteritis nodosa - Revision history

Danbot: Add verified PubMed references (PMIDs 24485157, 38068989)

2026-03-22T10:55:47Z

Add verified PubMed references (PMIDs 24485157, 38068989)

← Older revision		Revision as of 10:55, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Necrotizing [[vasculitis]] of small- and medium-sized blood vessels		*Necrotizing [[vasculitis]] of small- and medium-sized blood vessels<ref>Hernández-Rodríguez J, et al. Diagnosis and classification of polyarteritis nodosa. J Autoimmun. 2014 Feb-Mar;48-49:84-9. PMID 24485157</ref>
	*Skin, musculoskeletal, CNS, and GI tract (spares lung)		*Skin, musculoskeletal, CNS, and GI tract (spares lung)
	*Predilection to arterial bifurcations and branch sites		*Predilection to arterial bifurcations and branch sites<ref>Wolff L, et al. Polyarteritis Nodosa: Old Disease, New Etiologies. Int J Mol Sci. 2023 Nov 23;24(23). PMID 38068989</ref>
	*Microaneurysm, [[thromboembolism\|thrombosis, emboli]], organ ischemia, and infarction		*Microaneurysm, [[thromboembolism\|thrombosis, emboli]], organ ischemia, and infarction
	*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]		*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]

Rossdonaldson1: /* Background */

2023-08-02T17:35:01Z

Background

← Older revision		Revision as of 17:35, 2 August 2023
Line 5:		Line 5:
	*Microaneurysm, [[thromboembolism\|thrombosis, emboli]], organ ischemia, and infarction		*Microaneurysm, [[thromboembolism\|thrombosis, emboli]], organ ischemia, and infarction
	*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]		*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]

			{{Primary Vasculitis DDX}}

	==Clinical Features==		==Clinical Features==

Elcatracho: /* Differential Diagnosis */

2021-02-03T18:25:05Z

Differential Diagnosis

← Older revision		Revision as of 18:25, 3 February 2021
Line 26:		Line 26:
	==Differential Diagnosis==		==Differential Diagnosis==
	*Embolism, thrombosis, atherosclerosis		*Embolism, thrombosis, atherosclerosis
	*[[HIV]], [[Hepatitis]], IE, mycotic aneurysm		*[[HIV]], [[Hepatitis]], IE, [[mycotic aneurysm]]
	*Fibromuscular dysplasia		*Fibromuscular dysplasia
	*Microscopic polyangiitis, [[Granulomatosis with polyangiitis]] (Wegener's), [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss), IgA vasculitis, drug-induced vasculitis, [[connective tissue disease]], [[SLE]], cryoglobulinemic vasculitis		*Microscopic polyangiitis, [[Granulomatosis with polyangiitis]] (Wegener's), [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss), IgA vasculitis, drug-induced vasculitis, [[connective tissue disease]], [[SLE]], cryoglobulinemic vasculitis

Rossdonaldson1: /* Clinical Features */

2020-09-09T16:56:26Z

Clinical Features

← Older revision		Revision as of 16:56, 9 September 2020
Line 7:		Line 7:

	==Clinical Features==		==Clinical Features==
			[[File:PMC3505767 ad-24-383-g005.png\|thumb\|Cutaneous polyarteritis nodosa. (A) The patient presented with livedo reticularis on the lower legs. (B) Vasculitis involves the muscular artery of the deep dermis.]]
	*Cutaneous [[rash\|lesion]] + adult onset [[hypertension]]		*Cutaneous [[rash\|lesion]] + adult onset [[hypertension]]
	*Men > women (2:1)		*Men > women (2:1)

Rossdonaldson1: /* Classification */

2020-09-09T16:54:44Z

Classification

← Older revision		Revision as of 16:54, 9 September 2020
Line 45:		Line 45:

	===Diagnosis===		===Diagnosis===
	====~~Classification~~====		====American College of Rheumatology Criteria====
	*American College of Rheumatology 10 criteria (at least 3~~, has~~ 82% sensitivity and 87% specificity)		''Need at least 3/10 (82% sensitivity and 87% specificity)''
	**Unexplained weight loss greater than 4kg		*Unexplained weight loss greater than 4kg
	**Livedo reticularis		*Livedo reticularis
	**[[Testicular Pain]] or tenderness		*[[Testicular Pain]] or tenderness
	**Myalgia (excluding shoulder and hip girdle), weakness of muscles, tenderness of leg muscles, or polyneuropathy		*Myalgia (excluding shoulder and hip girdle), weakness of muscles, tenderness of leg muscles, or polyneuropathy
	**Mononeuropathy or polyneuropathy		*Mononeuropathy or polyneuropathy
	**New-onset diastolic blood pressure > 90mmHg		*New-onset diastolic blood pressure > 90mmHg
	**Elevated serum BUN (>40mg/dL or 14.3mmol/L) or creatinine (>1.5mg/dL or 132 mmol/L)		*Elevated serum BUN (>40mg/dL or 14.3mmol/L) or creatinine (>1.5mg/dL or 132 mmol/L)
	**Evidence of HBV infection (serology)		*Evidence of HBV infection (serology)
	**Characteristic arteriographic abnormalities not resulting fro noninflammatory disease processes		*Characteristic arteriographic abnormalities not resulting fro noninflammatory disease processes
	**Biopsy of small- or medium-sized artery containing polymorphonuclear cells		*Biopsy of small- or medium-sized artery containing polymorphonuclear cells

	==Management==		==Management==

Rossdonaldson1 at 16:53, 9 September 2020

2020-09-09T16:53:49Z

@@ Line 6: / Line 6: @@
 *Etiology: Idiopathic, [[HBV]], [[hepatitis C|HCV]], hairy cell [[leukemia]]
-==Evaluation==
+==Clinical Features==
 *Cutaneous [[rash|lesion]] + adult onset [[hypertension]]
 *Men > women (2:1)
@@ Line 23: / Line 22: @@
 *[[Myocardial ischemia]] and [[heart failure]]
 *[[Myalgia]] (elevated CK)
 ==Differential Diagnosis==
@@ Line 45: / Line 30: @@
 ==Evaluation==
 *Definitive: Tissue biopsy
 *Labs:
@@ Line 57: / Line 43: @@
 **CT/MRI
 *Consider: [[CXR]], blood cultures, autoimmune serologic testing (ANCA, ANA, RF) to rule out other diseases
 ==Management==

ClaireLewis at 17:35, 16 October 2019

2019-10-16T17:35:25Z

← Older revision		Revision as of 17:35, 16 October 2019
Line 3:		Line 3:
	*Skin, musculoskeletal, CNS, and GI tract (spares lung)		*Skin, musculoskeletal, CNS, and GI tract (spares lung)
	*Predilection to arterial bifurcations and branch sites		*Predilection to arterial bifurcations and branch sites
	*Microaneurysm, [[~~thromboemboli~~\|thrombosis, emboli]], organ ischemia, and infarction		*Microaneurysm, [[thromboembolism\|thrombosis, emboli]], organ ischemia, and infarction
	*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]		*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]

ClaireLewis at 17:35, 16 October 2019

2019-10-16T17:35:02Z

← Older revision		Revision as of 17:35, 16 October 2019
Line 3:		Line 3:
	*Skin, musculoskeletal, CNS, and GI tract (spares lung)		*Skin, musculoskeletal, CNS, and GI tract (spares lung)
	*Predilection to arterial bifurcations and branch sites		*Predilection to arterial bifurcations and branch sites
	*Microaneurysm, thrombosis, emboli, ~~organic~~ ischemia, and infarction		*Microaneurysm, [[thromboemboli\|thrombosis, emboli]], organ ischemia, and infarction
	*Etiology: Idiopathic, HBV, HCV, hairy cell leukemia		*Etiology: Idiopathic, [[HBV]], [[hepatitis C\|HCV]], hairy cell [[leukemia]]

	==Evaluation==		==Evaluation==
	===Clinical Features===		===Clinical Features===
	*Cutaneous lesion + adult onset hypertension		*Cutaneous [[rash\|lesion]] + adult onset [[hypertension]]
	*Men > women (2:1)		*Men > women (2:1)
	*Peak age 40-60s		*Peak age 40-60s
Line 20:		Line 20:
	*Renovascular arteritis → [[hypertension]]		*Renovascular arteritis → [[hypertension]]
	*Peripheral neuropathies (mononeuritis multiplex, polyneuropathy)		*Peripheral neuropathies (mononeuritis multiplex, polyneuropathy)
	*Mesenteric vasculitis (abdominal angina, ischemia, infarction, perforation)		*Mesenteric vasculitis (abdominal angina, [[mesenteric ischemia\|ischemia]], infarction, perforation)
	*[[Myocardial ischemia]] and [[heart failure]]		*[[Myocardial ischemia]] and [[heart failure]]
	*Myalgia (elevated CK)		*[[Myalgia]] (elevated CK)

	===Classification===		===Classification===
Line 37:		Line 37:
	**Biopsy of small- or medium-sized artery containing polymorphonuclear cells		**Biopsy of small- or medium-sized artery containing polymorphonuclear cells

	==~~Workup~~==
			==Differential Diagnosis==
			*Embolism, thrombosis, atherosclerosis
			*[[HIV]], [[Hepatitis]], IE, mycotic aneurysm
			*Fibromuscular dysplasia
			*Microscopic polyangiitis, [[Granulomatosis with polyangiitis]] (Wegener's), [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss), IgA vasculitis, drug-induced vasculitis, [[connective tissue disease]], [[SLE]], cryoglobulinemic vasculitis

			==Evaluation==
	*Definitive: Tissue biopsy		*Definitive: Tissue biopsy
	*Labs:		*Labs:
	**Cr, CK, ~~LFT~~ (elevated)		**Cr, CK, [[LFTs]] (elevated)
	**CBC (Leukocytosis, normochromic anemia, thrombocytosis)		**CBC ([[Leukocytosis]], normochromic [[anemia]], [[thrombocytosis]])
	**Hepatitis serology		**[[viral hepatitis\|Hepatitis serology]]
	**[[Urinalysis]] (proteinuria)		**[[Urinalysis]] ([[proteinuria]])
	**ESR/CRP		**ESR/CRP
	*Imaging		*Imaging
Line 49:		Line 56:
	**Arteriograms		**Arteriograms
	**CT/MRI		**CT/MRI
	*~~To consider~~: CXR, blood cultures, autoimmune serologic testing (ANCA, ANA, RF) to rule out other diseases		*Consider: [[CXR]], blood cultures, autoimmune serologic testing (ANCA, ANA, RF) to rule out other diseases

	~~==Differential Diagnosis==~~
	*Embolism, thrombosis, atherosclerosis
	*[[HIV]], [[Hepatitis]], IE, mycotic aneurysm
	*Fibromuscular dysplasia
	*Microscopic polyangiitis, [[Granulomatosis with polyangiitis]] (Wegener's), [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss), IgA vasculitis, drug-induced vasculitis, [[connective tissue disease]], [[SLE]], cryoglobulinemic vasculitis

	==Management==		==Management==
	*Rheumatology consult		*Rheumatology consult
	*May warrant surgical intervention if abdominal involvement		*May warrant surgical intervention if abdominal involvement
	*~~Corticosteroid~~:		*[[Corticosteroids]]:
	**[[Prednisone]] 1mg/kg		**[[Prednisone]] 1mg/kg
	**[[Methylprednisolone]] (7-15mg/kg, max 1000mg IV) for severe, organ threatening		**[[Methylprednisolone]] (7-15mg/kg, max 1000mg IV) for severe, organ threatening
Line 75:		Line 76:

	[[Category:Rheumatology]]		[[Category:Rheumatology]]
			[[Category:Vascular]]

ClaireLewis at 22:49, 13 November 2016

2016-11-13T22:49:27Z

← Older revision		Revision as of 22:49, 13 November 2016
Line 1:		Line 1:
	==Background==		==Background==
	*Necrotizing vasculitis of small- and medium-sized blood vessels		*Necrotizing [[vasculitis]] of small- and medium-sized blood vessels
	*Skin, musculoskeletal, CNS, and GI tract (spares lung)		*Skin, musculoskeletal, CNS, and GI tract (spares lung)
	*Predilection to arterial bifurcations and branch sites		*Predilection to arterial bifurcations and branch sites
Line 11:		Line 11:
	*Men > women (2:1)		*Men > women (2:1)
	*Peak age 40-60s		*Peak age 40-60s
	*Systemic: Fatigue, weight loss, weakness, fever, arthralgia		*Systemic: Fatigue, weight loss, weakness, [[fever]], [[arthralgia]]
	*Cutaneous lesions (1/3 patients)		*Cutaneous lesions (1/3 patients)
	**Tender erythematous nodules		**Tender erythematous nodules
	**Palpable ~~pupura~~ (fingers, ankles, malleoli, pretibial)		**Palpable [[purpura]] (fingers, ankles, malleoli, pretibial)
	**Digital cyanosis		**Digital cyanosis
	**Splinter hemorrhages		**Splinter hemorrhages
	**Livedo reticularis		**Livedo reticularis
	*Renovascular arteritis → hypertension		*Renovascular arteritis → [[hypertension]]
	*Peripheral neuropathies (mononeuritis multiplex, polyneuropathy)		*Peripheral neuropathies (mononeuritis multiplex, polyneuropathy)
	*Mesenteric vasculitis (abdominal angina, ischemia, infarction, perforation)		*Mesenteric vasculitis (abdominal angina, ischemia, infarction, perforation)
	*Myocardial ischemia and heart failure		*[[Myocardial ischemia]] and [[heart failure]]
	*Myalgia (elevated CK)		*Myalgia (elevated CK)

Line 28:		Line 28:
	**Unexplained weight loss greater than 4kg		**Unexplained weight loss greater than 4kg
	**Livedo reticularis		**Livedo reticularis
	**Testicular ~~pain~~ or tenderness		**[[Testicular Pain]] or tenderness
	**Myalgia (excluding shoulder and hip girdle), weakness of muscles, tenderness of leg muscles, or polyneuropathy		**Myalgia (excluding shoulder and hip girdle), weakness of muscles, tenderness of leg muscles, or polyneuropathy
	**Mononeuropathy or polyneuropathy		**Mononeuropathy or polyneuropathy
Line 54:		Line 54:
	*Embolism, thrombosis, atherosclerosis		*Embolism, thrombosis, atherosclerosis
	*[[HIV]], [[Hepatitis]], IE, mycotic aneurysm		*[[HIV]], [[Hepatitis]], IE, mycotic aneurysm
	*Fibromuscular ~~dysplagia~~		*Fibromuscular dysplasia
	*Microscopic polyangiitis, Granulomatosis with polyangiitis (Wegener's), ~~Chug~~-Strauss, IgA vasculitis, drug-induced vasculitis, connective tissue disease, SLE, cryoglobulinemic vasculitis		*Microscopic polyangiitis, [[Granulomatosis with polyangiitis]] (Wegener's), [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss), IgA vasculitis, drug-induced vasculitis, [[connective tissue disease]], [[SLE]], cryoglobulinemic vasculitis

	==Management==		==Management==
Line 64:		Line 64:
	**[[Methylprednisolone]] (7-15mg/kg, max 1000mg IV) for severe, organ threatening		**[[Methylprednisolone]] (7-15mg/kg, max 1000mg IV) for severe, organ threatening
	*Immunosuppressive agent for moderate to severe		*Immunosuppressive agent for moderate to severe
	**Cyclophosphamide (600mg/m2<sup>) q2weeks x 3 doses		**[[Cyclophosphamide]] (600mg/m2<sup>) q2weeks x 3 doses
	*ACEI or ARB for hypertension		*[[ACEI]] or [[ARB]] for hypertension

	==References==		==References==

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T21:31:03Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 21:31, 2 October 2016
Line 43:		Line 43:
	**CBC (Leukocytosis, normochromic anemia, thrombocytosis)		**CBC (Leukocytosis, normochromic anemia, thrombocytosis)
	**Hepatitis serology		**Hepatitis serology
	**UA (proteinuria)		**[[Urinalysis]] (proteinuria)
	**ESR/CRP		**ESR/CRP
	*Imaging		*Imaging

Polyarteritis nodosa - Revision history

Danbot: Add verified PubMed references (PMIDs 24485157, 38068989)

Rossdonaldson1: /* Background */

Elcatracho: /* Differential Diagnosis */

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1: /* Classification */

Rossdonaldson1 at 16:53, 9 September 2020

ClaireLewis at 17:35, 16 October 2019

ClaireLewis at 17:35, 16 October 2019

ClaireLewis at 22:49, 13 November 2016

Rossdonaldson1: Text replacement - "*UA" to "*Urinalysis"

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"