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Polyarteritis nodosa

Última revisión: 23 Sep 2025
Última actualización: 13 Feb 2024

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • age 40 to 60 years
  • fever
  • weight loss
  • myalgia or arthralgia
  • mononeuritis multiplex
  • paresthesia
  • muscle tenderness
  • abdominal pain
  • skin manifestations
  • diastolic blood pressure >90 mmHg
  • history of blood transfusion predating introduction of routine HBV screening
  • previous or current intravenous drug abuse
  • recent hepatitis B virus (HBV) infection
  • testicular pain
Todos los datos

Otros factores de diagnóstico

  • male sex
  • hairy cell leukemia
  • seizure
  • upper motor neuron weakness
  • gastrointestinal (GI) bleeding
  • peritonitis
  • monocular blindness
  • chest pain
  • congestive cardiac failure
  • tender breast lumps
Todos los datos

Factores de riesgo

  • hepatitis B virus (HBV) infection
  • age 40 to 60 years
  • hairy cell leukemia
  • history of blood transfusion predating introduction of routine HBV screening
  • hepatitis C virus (HCV) infection
  • male sex
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • CRP
  • erythrocyte sedimentation rate (ESR)
  • CBC
  • complement
  • serum creatinine
  • midstream urine analysis
  • liver function tests
  • hepatitis B virus (HBV) serology
  • hepatitis C virus (HCV) serology
  • cryoglobulins
  • blood culture
  • creatine kinase
  • antineutrophil cytoplasmic antibodies (ANCA)
  • antinuclear antibodies (ANA)
  • anti-double-stranded DNA antibodies (anti-dsDNA)
  • rheumatoid factor
  • antibodies to cyclic citrullinated peptides (anti-CCP antibodies)
  • lupus anticoagulant
  • immunoglobulin G antiphospholipid antibodies
  • B2 glycoprotein
  • fibrinogen
  • conventional digital subtraction angiography
  • echocardiography
Todos los datos

Pruebas diagnósticas que deben considerarse

  • MR angiography (MRA)
  • CT angiography
  • biopsy of affected tissue
  • HIV serology
  • genetic test for adenosine deaminase 2 (ADA2) deficiency
Todos los datos

Algoritmo de tratamiento

Agudo

non HBV-related PAN

HBV-related PAN

En curso

relapse of disease

Colaboradores

Autores

Ravi Suppiah, MBChB, PGDipSportMed, MD, FRACP

Consultant Rheumatologist

Auckland and Counties Manukau District Health Boards

Auckland

New Zealand

Divulgaciones

RS declares that he has no competing interests.

Joanna Robson, MBBS, PhD, MRCP

Rheumatology Registrar

Nuffield Orthopaedic Centre

Oxford

UK

Divulgaciones

JR declares that she has no competing interests.

Raashid Luqmani, DM, FRCP, FRCP(E)

Professor of Rheumatology

NIHR Musculoskeletal Biomedical Research Unit

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science

University of Oxford

Oxford

UK

Divulgaciones

RL is an author of a number of references cited in this topic.

Agradecimientos

Dr Ravi Suppiah, Dr Joanna Robson and Dr Raashid Luqmani would like to gratefully acknowledge Dr Loic Guillevin, the previous contributor to this topic. LG is an author of a number of references cited in this topic.

Peer reviewers

Alan Bridges, MD

Professor and Vice Chair

Department of Medicine

University of Wisconsin Hospital

Madison

WI

Disclosures

AB declares that he has no competing interests.

Richard Watts, MA, DM, FRCP

Consultant Rheumatologist

Ipswich Hospital

Ipswich

UK

Disclosures

RW has received fees for consulting from Roche Pharmaceuticals, manufacturer of rituximab. His department has received financial support from Wyeth Pharmaceuticals, manufacturer of etanercept, and from Schering-Plough, manufacturer of infliximab. RW is an author of a number of references cited in this topic.

Ellen C. Ebert, MD

Professor of Medicine

Department of Medicine

UMDNJ-Robert Wood Johnson Medical School

New Brunswick

NJ

Declarações

ECE declares that she has no competing interests.

Créditos aos pareceristas

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Declarações

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum. 1990;33:1094-1100. Resumo

Mahr A, Guillevin L, Poissonnet M, et al. Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener's granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum. 2004;51:92-99. Resumo

Colmegna I, Maldonado-Cocco JA. Polyarteritis nodosa revisited. Curr Rheumatol Rep. 2005;7:288-296. Resumo

Mukhtyar C, Guillevin L, Cid MC, et al. EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis. 2009 Mar;68(3):310-7Texto completo  Resumo

Ntatsaki E, Carruthers D, Chakravarty K, et al; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatology (Oxford). 2014 Dec;53(12):2306-9.Texto completo  Resumo

Jayne D, Rasmussen N, Andrassy K, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med. 2003 Jul 3;349(1):36-44.Texto completo  Resumo

De Groot K, Rasmussen N, Bacon PA, et al. Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2005 Aug;52(8):2461-9.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Polyarteritis nodosa images
  • Diagnósticos diferenciais

    • Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
    • Microscopic polyangiitis
    • Churg-Strauss syndrome
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
    • BSR and BHPR guidelines for the management of adults with ANCA-associated vasculitis
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Pneumonia: do I need a vaccine?

    Mais Folhetos informativos para os pacientes
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