Some General Information on Polyarteritis Nodosa

Question:

My father was recently diagnosed with PAN. This disease is totally new to me. Please help me learn more about PAN and critical information that I can share with my father's doctor.

Dr. Karen:

Since you have read as little as is on the net, as you know there is not much on PAN itself. Information on Systemic Vasculitis will give you more information also. I have posted some questions on the web site that may help getting started with your fathers doctor.

All I can give you some information prognosis for PAN, but I do not have all of your fathers medical information. There is a list of 10 criteria from The American College of Rheumatology developed in 1990:

• Weight loss of >4kg(8.8lbs) since beginning of illness
• Livedo reticlaris ( this is a rash usually on the legs that is discolored and usually painful)
• Testicular pain or tenderness
• Myalgia, weakness, or leg tenderness
• Mononeuropathy or polyneuropathy
• Development of hypertension
• Elevated BUN or creatinine unrelated to dehydration or obstruction.( This relates to kidney function and are blood tests)
• Presence of hepatitis B surface antigen or antibody in serum
• Arteriogram demonstrating aneurism or occlusions of the visceral arteries
• Biopsy of small or medium-sized artery containing granulocyte.

A patient should have at least 3 of the 10 ACR criteria in order to be included in any research studies, your fathers doctor may feel comfortable with only 2 criteria depending on your fathers clinical condition.

Your father’s prognosis will depend on what organs are involved. Also keep in mind that PAN was reclassified in 1994. Prior to that it had other vasculitis grouped in which included research studies. It appears that PAN has a better prognosis than the others, so do not be alarmed at some of the statistics. PAN tends to affect certain organs:

• Nerve
• Skin
• Kidney
• Gastrointestinal tract
• Heart
• Eye
• Genitals

The organs that seem to most effect prognosis are the kidneys. Normal kidney function is good, protein in the urine is not, but it depends on how much protein is the. Abdominal pain is common, it is abdominal angina and usually worse after eating. The worse thing that can happen is going from angina to ischemia (death of part of bowel wall) which can lead to perforation. The earlier the dx is made the better. Treatment with prednisone and or other drugs leads to remission in about 70% of people. I have also read that up 85% go into remission. It will all depend on how your father responds to treatment.

I am new at this. My specialty in Internal Medicine and I have not treated anyone with PAN, just learning myself. I hope this is helpful.