Panarteritis nodosa or polyarteritis nodosa is a rheumatic disease that leads to inflammation of the blood vessels. Although the disease is life-threatening without treatment, with treatment, the patient can usually be free of symptoms.
What is panarteritis nodosa?
Panarteritis nodosa, also known as classic polyarteritis nodosa, is one of the rheumatic diseases of the vasculitides group.
These rheumatic diseases are characterized by inflammation of the blood vessels. In panarteritis nodosa, the medium-sized arteries are usually affected. The arteries of the gastrointestinal tract, the nervous system, the musculoskeletal system and the kidneys are particularly affected. See gradinmath for What is Kneecap Arthrosis.
All wall layers of the affected arteries can become necrotic and inflamed, and nodular changes occasionally occur. There is a risk of vascular bulging, so-called aneurysms, which can lead to the formation of thrombi.
Furthermore, panarteritis nodosa leads to a poorer blood supply in the affected areas of the body due to the destruction of the vessels. As a result, panarteritis nodosa can lead to the death of the tissue supplied by the affected arteries.
The causes of panarteritis nodosa have not yet been fully clarified.
However, it is assumed that it is an autoimmune disease that breaks out due to previous infectious diseases. An autoimmune disease is a disease in which the immune system attacks and attacks the body’s own structures.
Some of the patients suffered from an infection with hepatitis B before the illness. It has been demonstrated that deposits of antibodies can occur on the vessel walls in these affected individuals. These deposits trigger immune reactions there, which lead to the inflammatory processes mentioned and their consequences.
In addition to hepatitis B, pathogens such as the Coxsackie, Epstein-Barr, cytomegalovirus and a human herpes virus are suspected of being able to trigger panarteritis nodosa.
Symptoms, Ailments & Signs
Panarteritis nodosa shows up in almost all those affected with very non-specific symptoms. For example, fever, weight loss, night sweats and muscle and joint pain occur in around 95 percent of those affected. The symptoms are thus reminiscent of influenza.
Four out of five sufferers eventually develop neuropathy due to this form of vasculitis. This can manifest itself in visual disturbances and seizures, among other things. There is also a lack of blood supply to the nerves. In many of those affected, the digestive system is also involved, which can lead to severe and intermittent pain.
Nausea and vomiting occur. In severe cases, infarctions can also occur in the liver, pancreas or spleen. An infarction of individual sections of the intestine can also occur. In men, testicular pain can occur due to poor blood circulation.
Angina pectoris often develops in both sexes. Panarteritis nodosa also has a negative effect on the mobility of the affected person. Movements of the joints quickly lead to pain. Skin changes can also occur. Above all, more or less bizarre skin markings appear, which can be traced back to a slow blood flow. The risk of heart attack is increased.
Diagnosis & History
The symptoms of panarteritis nodosa can be quite diverse. This can lead to high fever, loss of appetite, weight loss, weakness and night sweats.
Other symptoms depend on the area in which the panarteritis nodosa occurs:
Severe abdominal pain suggests disease in an artery in the gastrointestinal tract. If the musculoskeletal system is involved, muscle and joint pain is to be expected.
In the heart area, there is pain radiating into the chest, pressure behind the breastbone, or a feeling of heartburn. If panarteritis nodosa in the area of the heart blocks the vessel, there is a risk of a heart attack.
In the brain, panarteritis nodosa can cause headaches, dizziness, vomiting, paralysis, speech disorders, or even a stroke.
If an artery of the kidneys is affected, the blood pressure increases first. Later on, there is a risk of renal insufficiency.
Due to the variety of symptoms, making a diagnosis is not easy. An X-ray image of the blood vessels is helpful here, as the changes are visible here. Ultrasound examinations can be used to determine vascular constrictions and imaging methods such as MRT, X-rays or CT can be used to show disease foci in the body. The suspicion of panarteritis nodosa can ultimately be confirmed by taking and examining tissue samples from the affected areas.
As a rule, panarteritis nodosa does not heal itself. Since this disease is a life-threatening disease, treatment by a doctor is necessary in any case. If panarteritis nodosa is not treated, the patient dies in most cases.
Patients with this disease primarily suffer from severe weight loss. High fever and exhaustion can also occur and thus significantly reduce the patient’s quality of life. Stomach problems and intestinal problems also occur, so that those affected also suffer from nausea and vomiting. The joints can also be painful and swollen, resulting in restricted movement and thus limitations in the patient’s everyday life.
At night, those affected often suffer from insomnia and night sweats. This can also lead to depression and irritability in the patient. Without treatment, panarteritis nodosa leads to renal insufficiency and thus to the death of the patient. The disease can be treated with medication. There are no complications. With correct and early treatment, the patient’s life expectancy is not reduced.
When should you go to the doctor?
If the flu-like symptoms persist, it is advisable to consult a doctor. If the person concerned suffers from a fever, a general feeling of illness, an inner weakness or an unintentional loss of weight, the symptoms should be clarified. Report night sweats, pain or joint problems to a doctor. Discomfort in the muscular system, limitations in the musculoskeletal system and disorders of the digestive tract indicate a disease that needs to be treated. The affected person needs medical care for functional disorders or a seizure disorder.
Without treatment, it can become a life-threatening condition. In acute cases, the emergency services must be alerted. The characteristic feature of panarteritis nodosa is that patients report intermittent pain. In order to avert risks, you should refrain from taking pain medication until you have consulted your doctor. Nausea and vomiting as well as irregularities in the complexion should also be presented to a doctor.
If men suffer from testicular pain and sexual dysfunction, a comprehensive examination is advisable. Disorders of the blood flow or cardiovascular system are considered alarming and must be examined by a doctor as soon as possible to avoid complications. If there are impairments in coping with everyday life or if participation in usual leisure activities and sporting activities has to be restricted, a doctor is needed.
Treatment & Therapy
Panarteritis nodosa is initially treated with very high doses of corticosteroids to allow the inflammatory reactions to subside.
The dose of corticosteroids is then slowly reduced until the smallest possible and still effective dose has been found. With this dose, the treatment is continued for a longer period of time. It is also possible to give an additional or alternative form of immunosuppressants to suppress the immune system’s reaction against your own body.
To prevent serious damage, treatment should be given as soon as possible. It can also be helpful to have the treatment carried out in a center that specializes in panarteritis nodosa.
If an infectious disease is evident as the cause of panarteritis nodosa, it must of course also be treated. With the right and early treatment, complete freedom from symptoms can usually be achieved for the patient. Without treatment, however, a large proportion of those affected die within five years.
Outlook & Forecast
While polyarteritis nodosa was more often fatal 25 years ago, the quality of life and prognosis of those affected has clearly improved in recent years due to the spread of high-dose glucocorticoid-cytostatic drug combinations. Because while other forms of vasculitis often lead to relapses, this is rarely the case with polyarteritis nodosa.
With successful treatment in specialized centers, a remission lasting several years or even a complete remission can usually be achieved within the first three years. A good prognosis can therefore be assumed, especially since the five-year survival rate with appropriate therapy with glucocorticoids and the intake of cytostatics is over 80%. Because it is an incurable autoimmune disease, only the symptoms, not the causes, are treated. If the digestive organs, kidneys, nerves or brain are already more severely attacked or if hepatitis B is also present, the prognosis can only be assumed to be rather poor. Therefore, early diagnosis and combination treatment are all the more important.
However, for untreated disease, the five-year survival rate is only 13%. In these cases, without therapy, heart attack, stroke or kidney failure lead to death.
Because it is an autoimmune disease, it cannot be prevented. However, infectious diseases such as hepatitis B should at least be prevented by vaccination.
In most cases, those affected with panarteritis nodosa have very few or only limited options for aftercare, since this is a relatively rare disease. In order to avoid other complications or symptoms in the further course, the person concerned should definitely consult a doctor at an early stage. A doctor should be contacted as soon as the first signs or symptoms of the disease appear.
The treatment of the disease is usually carried out with the help of various drugs. The person concerned should always pay attention to the correct dosage and also to taking the medication regularly so that complications or other symptoms do not arise in the further course. In the event of side effects or if anything is unclear, a doctor should always be consulted first, and he or she should also be consulted if you have any questions.
In many cases, those affected are also dependent on the help and care of their own families due to panarteritis nodosa. This primarily alleviates or prevents depression and other mental upsets. It cannot be universally predicted whether panarteritis nodosa will lead to a reduced life expectancy for those affected.
You can do that yourself
In the case of panarteritis nodosa, everyday and self-help is primarily limited to combating the accompanying symptoms. The most important thing a patient with this condition can do is take care of themselves. It is advisable for the sufferer to get plenty of rest to counteract the symptoms of exhaustion.
Despite the recommendation that those affected should take it easy, it seems important to do regular motor exercises. These should be tackled in peace, since stress or overload are counterproductive. In order to keep the muscles in shape despite the rest periods, leisurely walks are the best choice. But everyday motor skills should also be trained. This is important so that any effects on the nervous system can be counteracted preventively. In addition, possible effects on the nervous system are noticed more quickly.
The diet should also be adjusted. Although panarteritis nodosa is accompanied by weight loss, which can be compensated for through diet if necessary, it is also important to control blood pressure. If you have high blood pressure, fish and various types of vegetables are the best options, while alcohol should be avoided.