Diagnostic and therapeutic problems of polyarteritis nodosa

Eleven patients with a diagnosis of polyarteritis nodosa were seen over an 8-year period in Cape Town, and evaluated as to clinical presentation, the most effective diagnostic approach, and the response to therapy. The major features of fever, abdominal pain, peripheral neuritis, myalgia/arthralgia, weight loss, proteinuria, positive urinary sediment and high white blood cell count should readily lead to the diagnosis which can be confirmed by multiple muscle biopsies. At the same time an ellipse of skin and subcutaneous fat can be taken. If the diagnosis is made early enough, an aggressive approach to therapy with steroid and immunosuppressive drugs can induce a response even in those patients who already have renal failure.