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[Periarteritis nodosa]
1Service de médecine interne Hôpital Claude-Huriez-CHRU 59037 Lille.
Abstract:
Periarteritis nodosa is a systemic vasculitis involving arteries with a diameter greater than 70-150 microns. Large vaccination against hepatitis B virus explains the decreased frequency of its association with hepatitis B virus observed in less than 10% of cases. Weight loss, fever, livedo, myalgias or arthralgias, mononeuropathy, gastrointestinal tract involvement, renal insufficiency, and cardiac failure are the most frequent clinical manifestations. Inflammatory syndrome and increased white blood cell count are common. Renal or digestive microaneurysms are present in more than 60% of cases. Prognosis is dependent of a five factors score corticosteroids with or without immunosuppressive drugs, result in 5-year survival rate over 60%. In hepatitis B virus-related periarteritis nodosa, corticosteroids are rapidly stopped; plasma exchanges in combination with antiviral agents (interferon alpha or lamivudine) give excellent results.
Insights
Periarteritis nodosa, a systemic vasculitis, presents with diverse symptoms and often involves microaneurysms. Treatment with corticosteroids and immunosuppressants improves survival, with specific therapies for hepatitis B virus-related cases.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Context:
- Periarteritis nodosa is a systemic vasculitis affecting medium-sized arteries.
- Hepatitis B virus (HBV) association has decreased due to vaccination.
- Clinical manifestations are varied, including fever, weight loss, and organ involvement.
Purpose:
- To summarize the key aspects of periarteritis nodosa.
- To highlight diagnostic and prognostic factors.
- To outline current treatment strategies.
Summary:
- The condition involves arteries >70-150 microns, with frequent microaneurysms in renal or digestive systems.
- Common symptoms include weight loss, fever, livedo, myalgias, arthralgias, mononeuropathy, renal insufficiency, and cardiac failure.
- An inflammatory syndrome and elevated white blood cell count are typical findings.
Impact:
- Prognosis is guided by a five-factor score, with corticosteroid-based regimens achieving >60% 5-year survival.
- For HBV-related periarteritis nodosa, rapid corticosteroid cessation combined with plasma exchange and antivirals yields excellent outcomes.
- Effective management strategies improve patient survival and quality of life.