eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Polyarteritis Nodosa: Follow-up

Author: Akaluck Thatayatikom, MD, Associate Professor and Chief, Department of Pediatrics, Division of Pediatric Allergy, Immunology, Rheumatology, University of Kentucky, Lexington
Contributor Information and Disclosures

Updated: Jun 17, 2009

Follow-up

Further Inpatient Care

  • Because of maximal immunosuppression at the beginning of polyarteritis nodosa (PAN) treatment, prevention of opportunistic infections, such as P carinii infection, may be necessary with oral trimethoprim-sulfamethoxazole.
  • ACE inhibitors can be used to control hypertension.
  • Unexplained abdominal pain may indicate silent bowel infarction.

Further Outpatient Care

  • Look for evidence of relapse by both physical examination and laboratory means.
  • Look for adverse effects of drugs.
  • Advise patients to avoid exposure to contagious disease.
  • Prevent opportunistic infections that may emerge during therapy.

Inpatient & Outpatient Medications

  • Continue or taper the steroids and immunosuppressive drugs according to the response.
  • Consider therapy to inhibit platelet aggregation.

Transfer

  • Transfer to a tertiary care center for patients who require renal replacement therapy.
  • Transfer to an emergency department if patients present with any of the following:
    • Respiratory distress
    • Acute abdomen
    • Disseminated infections
    • Acute CNS insults such as stroke or intracranial hemorrhages

Deterrence/Prevention

  • Avoid abrupt cessation of drugs, especially steroids.
  • Avoid exposure to contagious diseases.

Complications

  • CNS
    • Multiple mononeuropathies
    • Strokes
    • Brain hemorrhages
  • Skin
    • Ischemia
    • Gangrene
    • Ulcers
  • Kidney
    • Renal failure
    • Hypertension
    • Renal or perirenal hematomas
    • Ureteral stenosis
  • Gastrointestinal
    • Digestive tract bleeding
    • Bowel perforation
    • Malabsorption
    • Pancreatitis
    • Appendicitis
    • Cholecystitis
    • Liver infarction and hematomas
  • Cardiac and pulmonary
    • Congestive heart failure (CHF)
    • Atrioventricular block
    • Hypertension
    • Pleural effusion (PE) and pneumonopathy
  • Miscellaneous
    • Retinal detachment
    • Orchitis

Prognosis

  • Prognosis for individuals with polyarteritis nodosa varies, and the mortality rate can be as high as 20-30% despite aggressive therapy.
  • The most frequent causes of death in individuals with polyarteritis nodosa are GI hemorrhage and perforation, CHF, and infection.
  • Even with histologic evidence of effective control of inflammation, occlusion can result from fibrosis.
  • The 1-year survival rate for individuals with polyarteritis nodosa who tested positively for hepatitis B (HB) surface antigen was 70%; the rate for individuals with polyarteritis nodosa without infection was 85.

Miscellaneous

Medicolegal Pitfalls

  • To avoid delay in diagnosis, consider vasculitis when a patient presents with multisystem involvement with persistent nonspecific signs and symptoms.
  • Instruct patients about the dangers of exposure to contagious diseases and adverse effects of the medications.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Christine B Bernal, MD, and Muthukumar Vellaichamy, MD, FAAP, to the original writing and development of this article.



More on Polyarteritis Nodosa

Overview: Polyarteritis Nodosa
Differential Diagnoses & Workup: Polyarteritis Nodosa
Treatment & Medication: Polyarteritis Nodosa
Follow-up: Polyarteritis Nodosa
Multimedia: Polyarteritis Nodosa
References
Further Reading
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References

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Keywords

polyarteritis nodosa, PAN, periarteritis nodosa, PN, polyarteritis, periarteritis, necrotizing vasculitis, microscopic polyangiitis, MPA, arteritis nodosa, Kussmaul disease, Kussmaul's disease, small arteries, small-sized arteries, medium arteries, medium-sized arteries, hepatitis B, HB, hepatitis C, HC, vascular disease, hypertension, nephritic syndrome, nephrotic syndrome, progressive glomerulonephritis, RPGN, digestive tract bleeding, bowel perforation, malabsorption, cardiomegaly, pericarditis, pleural effusion, PE, ischemia, infarction, treatment, diagnosis

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Contributor Information and Disclosures

Author

Akaluck Thatayatikom, MD, Associate Professor and Chief, Department of Pediatrics, Division of Pediatric Allergy, Immunology, Rheumatology, University of Kentucky, Lexington
Akaluck Thatayatikom, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Rheumatology, Childhood Arthritis and Rheumatology Research Alliance, and Clinical Immunology Society
Disclosure: Nothing to disclose.

Medical Editor

James M Oleske, MD, MPH, François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases, Department of Pediatrics, New Jersey Medical School
James M Oleske, MD, MPH is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Thomas JA Lehman, MD, FAAP, FACR, Clinical Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Weill-Cornell University; Chief, Hospital for Special Surgery
Thomas JA Lehman, MD, FAAP, FACR is a member of the following medical societies: PM American Allergy Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Lawrence K Jung, MD, Chief, Division of Pediatric Rheumatology, Children's National Medical Center
Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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