What is the prognosis of Polyarteritis Nodosa

Polyarteritis nodosa is an autoimmune disease that affects arteries. Common areas affected include the muscles, joints, intestines (bowels), nerves, kidneys, and skin. Diagnosis of polyarteritis nodosa is confirmed by a biopsy of involved tissue or angiography. Treatment is directed toward decreasing the inflammation of the arteries.

Outlook (prognosis) of Polyarteritis Nodosa

Some people respond promptly to therapy and can taper off treatment over many months. Others require long-term treatment. The outlook for patients with polyarteritis nodosa depends on the degree of damage to affected organs and the response to treatments. For those patients with underlying hepatitis B infection, eradication of the virus is essential for optimal outcome.

Effects of Polyarteritis Nodosa

In individual organs, polyarteritis nodosa can have the following effects:

• Kidneys- Kidney failure and high blood pressure related to kidney injury
• Nervous system- Nerve injury in the arms or legs, which may cause numbness, tingling, or loss of sensation and movement caused by injury to one specific nerve bundle. In the brain, damage can trigger strokes, seizures or sudden alterations in brain function.
• Abdominal organs- Pain in the bowel, liver or pancreas, especially after eating, or even death of part of an organ caused by an interruption in blood supply. Arterial aneurysms, which are balloon-like swellings that develop along an artery in areas where vasculitis has weakened the arterial wall, may suddenly rupture. This can lead to life-threatening bleeding inside the abdomen, with severe abdominal pain.
• Heart- Heart attack, as well as inflammation of the lining of the heart (pericarditis). Congestive heart failure can make breathing difficult, as fluid backs up behind the heart into the lungs.
• Skin- Rashes, skin nodules and a rash (purpura) caused by bleeding from damaged capillaries

Prevention of Polyarteritis Nodosa

There is no way to prevent most cases of polyarteritis nodosa.

Being vaccinated against hepatitis B, and avoiding activities that increase the risk of hepatitis, such as sharing needles during intravenous drug use or having unprotected sex, may prevent hepatitis-related polyarteritis nodosa.

The treatment of polyarteritis nodosa (PAN) has improved dramatically. Previously, untreated PAN was usually fatal within weeks to months, with mortality often associated with kidney failure, cardiac complications, or GI complications. Therefore, early diagnosis and treatment are critical in PAN.

High dose steroids and cyclophosphamide are often used to get the inflammation under control (remission induction). Once under control treatment is often continued for 12 months with low dose treatment and then can be stopped in some patients.

Patients with hepatitis B virus infection will need specific treatment for the virus infection with anti-viral drugs, usually under specialist care.

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