Polyarteritis nodosa natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Polyarteritis nodosa}} | {{Polyarteritis nodosa}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[User:Haritha|Haritha Machavarapu, M.B.B.S.]] | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[User:Haritha|Haritha Machavarapu, M.B.B.S.]]{{SSW}} | ||
==Overview== | ==Overview== | ||
PAN if left untreated, the [[disease]] is fatal in most cases. The most serious associated conditions generally involve the [[kidneys]] and [[gastrointestinal tract]]. Common complications of PAN include [[Stroke]],[[Kidney failure]], [[myocardial infarction|heart attack]],[[Intestinal]] [[necrosis]] and [[perforation]]. Prognosis is generally good if the treatment is started.Therapy results in remissions or cures in 90% of cases. Guillevin and coworkers have described five prognostic factors that predict high probability of mortality and are considered indications for another [[Immunosuppressive therapy|immunosuppressive]] drug in addition to [[prednisone]]. | |||
==Natural History== | ==Natural History== | ||
* PAN if left untreated, the [[disease]] is fatal in most cases. | |||
* The most serious associated conditions generally involve the [[kidneys]] and [[gastrointestinal tract]]. | |||
* Without treatment, the outlook is poor. | |||
==Complications== | ==Complications== | ||
* Common complications of PAN include: | |||
* [[Stroke]] | ** [[Stroke]] | ||
* [[Kidney failure]] | ** [[Kidney failure]] | ||
* [[myocardial infarction|Heart attack]] | ** [[myocardial infarction|Heart attack]] | ||
* Intestinal [[necrosis]] | ** [[Intestinal]] [[necrosis]] | ||
** [[perforation]] | |||
==Prognosis== | ==Prognosis== | ||
Therapy results in remissions or cures in 90% of cases. Current treatments using steroids and other drugs that suppress the immune system (such as cyclophosphamide) can improve symptoms and the chance of long-term survival. Guillevin and coworkers have described five prognostic factors that predict high probability of mortality and are considered indications for another immunosuppressive drug in addition to [[prednisone]]. | * Prognosis is generally good if the treatment is started. | ||
* Therapy results in remissions or cures in 90% of cases. | |||
* Current treatments using [[steroids]] and other drugs that suppress the [[immune system]] (such as [[cyclophosphamide]]) can improve symptoms and the chance of long-term survival.<ref name="pmid42314">{{cite journal |vauthors=Leib ES, Restivo C, Paulus HE |title=Immunosuppressive and corticosteroid therapy of polyarteritis nodosa |journal=Am. J. Med. |volume=67 |issue=6 |pages=941–7 |date=December 1979 |pmid=42314 |doi= |url=}}</ref> | |||
* Guillevin and coworkers have described five prognostic factors that predict high probability of mortality and are considered indications for another [[Immunosuppressive therapy|immunosuppressive]] drug in addition to [[prednisone]].<ref name="pmid8569467">{{cite journal |vauthors=Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, Lortholary O, Thibult N, Casassus P |title=Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients |journal=Medicine (Baltimore) |volume=75 |issue=1 |pages=17–28 |date=January 1996 |pmid=8569467 |doi= |url=}}</ref> | |||
# [[Proteinuria]] >1g/day | # [[Proteinuria]] >1g/day | ||
#[[Azotemia]] | #[[Azotemia]] | ||
#[[Cardiomyopathy]] | #[[Cardiomyopathy]] | ||
#Gastrointestinal involvement | #[[Gastrointestinal]] involvement | ||
#Central nervous system disease | #[[Central nervous system]] disease With none of these factors, 5-year mortality is 12%. With 2 or more 5-year mortality is 46%<ref>Kelley's Textbook of Rheumatology,8th edition</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 22:42, 15 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Haritha Machavarapu, M.B.B.S.Sargun Singh Walia M.B.B.S.[3]
Overview
PAN if left untreated, the disease is fatal in most cases. The most serious associated conditions generally involve the kidneys and gastrointestinal tract. Common complications of PAN include Stroke,Kidney failure, heart attack,Intestinal necrosis and perforation. Prognosis is generally good if the treatment is started.Therapy results in remissions or cures in 90% of cases. Guillevin and coworkers have described five prognostic factors that predict high probability of mortality and are considered indications for another immunosuppressive drug in addition to prednisone.
Natural History
- PAN if left untreated, the disease is fatal in most cases.
- The most serious associated conditions generally involve the kidneys and gastrointestinal tract.
- Without treatment, the outlook is poor.
Complications
- Common complications of PAN include:
Prognosis
- Prognosis is generally good if the treatment is started.
- Therapy results in remissions or cures in 90% of cases.
- Current treatments using steroids and other drugs that suppress the immune system (such as cyclophosphamide) can improve symptoms and the chance of long-term survival.[1]
- Guillevin and coworkers have described five prognostic factors that predict high probability of mortality and are considered indications for another immunosuppressive drug in addition to prednisone.[2]
- Proteinuria >1g/day
- Azotemia
- Cardiomyopathy
- Gastrointestinal involvement
- Central nervous system disease With none of these factors, 5-year mortality is 12%. With 2 or more 5-year mortality is 46%[3]
References
- ↑ Leib ES, Restivo C, Paulus HE (December 1979). "Immunosuppressive and corticosteroid therapy of polyarteritis nodosa". Am. J. Med. 67 (6): 941–7. PMID 42314.
- ↑ Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, Lortholary O, Thibult N, Casassus P (January 1996). "Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients". Medicine (Baltimore). 75 (1): 17–28. PMID 8569467.
- ↑ Kelley's Textbook of Rheumatology,8th edition