|
|
| Line 4: |
Line 4: |
|
| |
|
| ==Overview== | | ==Overview== |
| | PAN must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3]. |
| | |
| | OR |
| | |
| | [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3]. |
|
| |
|
| ==Differentiating Polyarteritis Nodosa from other Diseases== | | ==Differentiating Polyarteritis Nodosa from other Diseases== |
| Line 16: |
Line 21: |
| *[[Mycotic aneurysm]] | | *[[Mycotic aneurysm]] |
| *[[Atherosclerosis]] | | *[[Atherosclerosis]] |
| ===== Differentiating Polyarteritis nodosa from other diseases that may cause [[arthritis]] and [[rash]]=====
| | [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3]. |
| <span style="font-size:85%">'''Abbreviations:'''
| |
| '''ANA:''' [[Anti-nuclear antibody|Antinuclear antibody]], '''RF:''' [[Rheumatoid factor]], '''Anti-CCp:''' [[Anti-citrullinated protein antibody|Anti-cyclic citrullinated protein antibody]], '''Anti U1RNP:''' Anti-U1 ribonucleoprotein antibodies , '''Anti Sm :''' Anti-Sm antibodies, '''Anti Ro:''' Anti Ro antibody also called anti-Sjögren's-syndrome-related antigen A antibody, '''Anti-dsDNA:''' [[Anti-dsDNA antbodies|Anti-double stranded DNA]].
| |
| </span>
| |
| <small>
| |
| {| class="wikitable"
| |
| ! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
| |
| ! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" |Arthritis
| |
| ! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" |Auto-antibodies
| |
| ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Raynaud phenomenon
| |
| ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Rash pattern
| |
| ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Distinguishing/specific features
| |
| |-
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Polyarthritis
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Tenderness
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Edema
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Deformity /Erosion
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Pattern
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |ANA
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |RF
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-CCp
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti U1RNP
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti Sm
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti Ro
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-dsDNA
| |
| |-
| |
| | rowspan="3" align="center" style="background:#DCDCDC;" |Vasculitis
| |
| | align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]]<ref name="pmid20112401">{{cite journal |vauthors=Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, Bienvenu B, Mouthon L, Guillevin L |title=Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database |journal=Arthritis Rheum. |volume=62 |issue=2 |pages=616–26 |year=2010 |pmid=20112401 |doi=10.1002/art.27240 |url=}}</ref>
| |
| | align="center" | -
| |
| | align="center" | +/-
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |General and mild
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |
| |
| |[[Tenderness|Tender]] [[Erythematous rash|erythematous nodules]], [[purpura]], [[livedo reticularis]], [[bullous]] or [[Vesicular|vesicular eruption]]
| |
| |[[Testicular pain]] or [[tenderness]] and [[neuropathies]]
| |
| |-
| |
| | align="center" style="background:#DCDCDC;" |[[Giant cell]]<ref name="pmid17031245">{{cite journal |vauthors=Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA |title=Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review |journal=Am. J. Med. Sci. |volume=332 |issue=4 |pages=198–204 |year=2006 |pmid=17031245 |doi= |url=}}</ref>
| |
| | align="center" | -
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" | -
| |
| | align="center" |Distal extremity
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | rowspan="2" align="center" | -
| |
| |Rare
| |
| |Involvement of cranial branches of arteries, visual loss
| |
| |-
| |
| | align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]<ref name="pmid12655">{{cite journal |vauthors=Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE |title=Takayasu's arteritis. Clinical study of 107 cases |journal=Am. Heart J. |volume=93 |issue=1 |pages=94–103 |year=1977 |pmid=12655 |doi= |url=}}</ref>
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" | +/-
| |
| | align="center" | +/-
| |
| | align="center" | -
| |
| | align="center" |Transient extremity
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |[[Erythema nodosum]], [[pyoderma gangrenosum]]
| |
| |Absent or weak peripheral pulse
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]<ref name="pmid25074031">{{cite journal |vauthors=Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA |title=Treatment of osteonecrosis in systemic lupus erythematosus: a review |journal=Curr Rheumatol Rep |volume=16 |issue=9 |pages=441 |year=2014 |pmid=25074031 |doi=10.1007/s11926-014-0441-8 |url=}}</ref>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |Small joints
| |
| | align="center" |↑
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" | -
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" |<nowiki>+</nowiki>
| |
| |[[Malar rash]] and [[photosensitivity]]
| |
| |
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])<ref name="pmid11567728">{{cite journal |vauthors=Lee DM, Weinblatt ME |title=Rheumatoid arthritis |journal=Lancet |volume=358 |issue=9285 |pages=903–11 |year=2001 |pmid=11567728 |doi=10.1016/S0140-6736(01)06075-5 |url=}}</ref>
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" |Small and large joints
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |↑↑
| |
| | align="center" |↑↑
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | +
| |
| |[[Subcutaneous]] [[nodules]]
| |
| |Erosive [[arthropathy]]
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |Rhupus<ref name="pmid3382309">{{cite journal |vauthors=Panush RS, Edwards NL, Longley S, Webster E |title='Rhupus' syndrome |journal=Arch. Intern. Med. |volume=148 |issue=7 |pages=1633–6 |year=1988 |pmid=3382309 |doi= |url=}}</ref>
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" | +
| |
| | align="center" |Small and large joints
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |↑
| |
| | align="center" | +
| |
| |[[Malar rash]] and [[photosensitivity]]
| |
| |Erosive [[arthropathy]]
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Mixed connective tissue disease]] (MCTD)<ref name="pmid21959290">{{cite journal |vauthors=Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M |title="To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity |journal=Semin. Arthritis Rheum. |volume=41 |issue=4 |pages=589–98 |year=2012 |pmid=21959290 |doi=10.1016/j.semarthrit.2011.07.010 |url=}}</ref>
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | +
| |
| | align="center" |Small and large joints
| |
| | align="center" |<nowiki>-</nowiki>
| |
| | align="center" |↑↑
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | +
| |
| |Cutaneous eruptions, [[Gottron's papules|gottron’s papules]], photodistributed [[erythema]], [[Poikiloderma of civatte|poikiloderma]], and [[calcinosis cutis]]
| |
| |Overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) that lead to more than one diagnosis
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD)<ref name="pmid1757934">{{cite journal |vauthors=Alarcón GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Willkens RF |title=Early undifferentiated connective tissue disease. I. Early clinical manifestation in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease |journal=J. Rheumatol. |volume=18 |issue=9 |pages=1332–9 |year=1991 |pmid=1757934 |doi= |url=}}</ref>
| |
| | align="center" | +
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |Lower extremity
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | +
| |
| |[[Erythematous]] [[macules]], patches, or [[papules]] with delicate scale
| |
| |Multiple connective tissue diseases with no enough criteria for a single diagnosis
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc)<ref name="pmid3361530">{{cite journal |vauthors=LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F |title=Scleroderma (systemic sclerosis): classification, subsets and pathogenesis |journal=J. Rheumatol. |volume=15 |issue=2 |pages=202–5 |year=1988 |pmid=3361530 |doi= |url=}}</ref>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" |Lower extremity
| |
| | align="center" |↑↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" |↑
| |
| | align="center" | +
| |
| |[[Hyperkeratosis]], [[edema]], and [[erythema]]
| |
| |[[Sclerodactyly]], [[Telangiectasias]], [[Calcinosis]], [[Malignant hypertension]], [[acute renal failure]]
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Sjögren’s syndrome]]<ref name="pmid15485020">{{cite journal |vauthors=Roguedas AM, Misery L, Sassolas B, Le Masson G, Pennec YL, Youinou P |title=Cutaneous manifestations of primary Sjögren's syndrome are underestimated |journal=Clin. Exp. Rheumatol. |volume=22 |issue=5 |pages=632–6 |year=2004 |pmid=15485020 |doi= |url=}}</ref>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |[[Lower extremity]], axiallary creases
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |↑
| |
| | align="center" |↑
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |[[Xerosis]], scaly skin, annular [[erythema]]
| |
| | |
| |[[Keratoconjunctivitis sicca]]
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Behçet's Syndrome|Behçet’s syndrome]]<ref name="pmid11760398">{{cite journal |vauthors=Tunç R, Uluhan A, Melikoğlu M, Ozyazgan Y, Ozdoğan H, Yazici H |title=A reassessment of the International Study Group criteria for the diagnosis (classification) of Behçet's syndrome |journal=Clin. Exp. Rheumatol. |volume=19 |issue=5 Suppl 24 |pages=S45–7 |year=2001 |pmid=11760398 |doi= |url=}}</ref>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" | -
| |
| | align="center" |medium and large joints
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |Recurrent and usually painful [[mucocutaneous]] ulcers, [[Acneiform eruption|acneiform]] [[lesions]], papulo-vesiculo-[[Pustular rash|pustular]] eruptions, superficial [[thrombophlebitis]]
| |
| |Male dominancy
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Kikuchi's Disease|Kikuchi’s disease]]<ref name="pmid16538388">{{cite journal |vauthors=Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M |title=Kikuchi-Fujimoto Disease: analysis of 244 cases |journal=Clin. Rheumatol. |volume=26 |issue=1 |pages=50–4 |year=2007 |pmid=16538388 |doi=10.1007/s10067-006-0230-5 |url=}}</ref>
| |
| | align="center" | -
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |medium and large joints
| |
| | align="center" |↑/↓
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |Transient skin [[rashes]], [[malar rash]], [[Macule|erythematous macules]], patches, [[papules]], or [[plaques]]
| |
| |May be associated with SLE
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Serum sickness]]<ref name="pmid3564980">{{cite journal |vauthors=Kunnamo I, Kallio P, Pelkonen P, Viander M |title=Serum-sickness-like disease is a common cause of acute arthritis in children |journal=Acta Paediatr Scand |volume=75 |issue=6 |pages=964–9 |year=1986 |pmid=3564980 |doi= |url=}}</ref>
| |
| | align="center" | +
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+/-</nowiki>
| |
| | align="center" | -
| |
| | align="center" |General
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |[[Pruritic disorders|Pruritic rash]], [[urticaria]] and/or serpiginous [[Rash|macular rash]]
| |
| |Self-limited
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Psoriatic arthritis]]<ref name="pmid8076388">{{cite journal |vauthors=Oriente P, Biondi-Oriente C, Scarpa R |title=Psoriatic arthritis. Clinical manifestations |journal=Baillieres Clin Rheumatol |volume=8 |issue=2 |pages=277–94 |year=1994 |pmid=8076388 |doi= |url=}}</ref>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |Small and large joints
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |[[Psoriasis]] and [[onychodystrophy]]
| |
| |[[Dactylitis]] (sausage digits)
| |
| |-
| |
| | colspan="2" align="center" style="background:#DCDCDC;" |[[Parvovirus B19|Human parvovirus B19 infection]]<ref name="pmid17384979">{{cite journal |vauthors=Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK |title=Secondary symptomatic parvovirus B19 infection in a healthy adult |journal=J Gen Intern Med |volume=22 |issue=6 |pages=877–8 |year=2007 |pmid=17384979 |pmc=2219874 |doi=10.1007/s11606-007-0173-9 |url=}}</ref>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" |<nowiki>+</nowiki>
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" |Small joints
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| | align="center" | -
| |
| |[[Erythematous rash|Erythematous rashes]]
| |
| |Rare in adults, [[Fifth disease|fifth's disease]] in children
| |
| |}
| |
| </small>
| |
|
| |
|
| ==References==
| | OR |
| {{reflist|2}}
| |
|
| |
|
| {{WH}}
| | [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3]. |
| {{WS}}
| |