Polyarteritis nodosa medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Haritha Machavarapu, M.B.B.S.
Overview
Medical Therapy
Treatment involves medications to suppress the immune system such as prednisone and cyclophosphamide. Addition of immunosuppressants like cyclophosphamide, methotrexate, azathioprine to corticosteroid therapy has better prognosis.[1]. Patients with hepatitis B associated polyarteritis nodosa are treated with corticosteroid therapy, antiviral agents and plasma exchanges.[2].[3]. Unlike hepatitis B associated PAN, Hepatitis C associated PAN is treated with Rituximab and corticosteoid therapy without antiviral agents, emphasizing the B cell targeted therapy.[4]
Mild cases of cutaneous polyarteritis nodosa are treated with nonsteroidal anti-inflammatory drugs[5]. Severe cases are treated with corticosteroid and adjunctive therapy. Antibiotics are added to the treatment of patients with antecedent streptococcal infections or high ASO titer.[6].
Intravenous immunoglobulin is suggested for treatment of corticosteroid therapy resistant cases, but the effect is transient.[7][8].It is also used in the treatment of Parvovirus B19 associated polyarteritis nodosa.[9]
References
- ↑ Leib ES, Restivo C, Paulus HE (1979). "Immunosuppressive and corticosteroid therapy of polyarteritis nodosa". Am. J. Med. 67 (6): 941–7. PMID 42314. Unknown parameter
|month=ignored (help) - ↑ Mouthon L (1999). "[Periarteritis nodosa induced by hepatitis B virus]". Pathol. Biol. (in French). 47 (3): 237–44. PMID 10214615. Unknown parameter
|month=ignored (help) - ↑ Trepo C, Guillevin L (2001). "Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis". J. Autoimmun. 16 (3): 269–74. doi:10.1006/jaut.2000.0502. PMID 11334492. Unknown parameter
|month=ignored (help) - ↑ Néel A, Masseau A, Hervier B; et al. (2011). "Life-threatening hepatitis C virus-associated polyarteritis nodosa successfully treated by rituximab". J Clin Rheumatol. 17 (8): 439–41. doi:10.1097/RHU.0b013e31823a58d7. PMID 22089995. Unknown parameter
|month=ignored (help) - ↑ Morgan AJ, Schwartz RA (2010). "Cutaneous polyarteritis nodosa: a comprehensive review". Int. J. Dermatol. 49 (7): 750–6. doi:10.1111/j.1365-4632.2010.04522.x. PMID 20618492. Unknown parameter
|month=ignored (help) - ↑ Díaz-Pérez JL, De Lagrán ZM, Díaz-Ramón JL, Winkelmann RK (2007). "Cutaneous polyarteritis nodosa". Semin Cutan Med Surg. 26 (2): 77–86. doi:10.1016/j.sder.2007.02.003. PMID 17544958. Unknown parameter
|month=ignored (help) - ↑ Kroiss M, Hohenleutner U, Gruss C, Glaessl A, Landthaler M, Stolz W (2001). "Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa". Dermatology (Basel). 203 (2): 188–9. PMID 11586025.
- ↑ Balbir-Gurman A, Nahir AM, Braun-Moscovici Y (2007). "Intravenous immunoglobulins in polyarteritis nodosa restricted to the limbs: case reports and review of the literature". Clin. Exp. Rheumatol. 25 (1 Suppl 44): S28–30. PMID 17428360.
- ↑ Viguier M, Guillevin L, Laroche L (2001). "Treatment of parvovirus B19-associated polyarteritis nodosa with intravenous immune globulin". N. Engl. J. Med. 344 (19): 1481–2. doi:10.1056/NEJM200105103441919. PMID 11357850. Unknown parameter
|month=ignored (help)