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Panarteritis nodosa • Inflammation of the arteries

Although panarteritis nodosa is rare, it is one of the most serious and dangerous rheumatic diseases. However, progress in therapy has significantly improved the patient's prognosis so that serious damage can often be avoided.

Panarteritis nodosa is rare, but it is one of the most serious rheumatic diseases.
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Overview of article content:

13 Typical signs of rheumatism

13 Typical signs of rheumatism

What is panarteritis nodosa?

Panarteritis nodosa is an inflammatory vascular disease (vasculitis), especially of the small and medium-sized arteries. Pathological immune processes, which are not yet fully known, lead to sagging of the vascular walls (aneurysm), from which small nodules can develop due to the accumulation of blood clots (nodosus = nodular).

There is also a risk of thrombi forming in the arteries that partially or completely occlude the vessel. Infarct tissue can die (necrotize), which is normally supplied by the closed vessel.

Symptoms of nodular panarteritis

The non-specific general symptoms that appear at the beginning of the disease include feeling sick, loss of appetite, weight loss and fever.

In addition, skin changes are often noticeable externally, for example areas with:

  • circumscribed or generalized, blotchy, reticulated or stripe-shaped, reddish-livid skin markings (also called "Livedo reticularis")
  • ulceration
  • dark colored or dead tissue

In most patients, the involvement of an internal organ also comes to the fore soon after the onset of the disease. The majority have kidney symptoms such as blood or protein excretion in the urine, decreased or increased urine production and arterial hypertension.

In more than three quarters of the patients, inflammatory changes in the heart arteries (coronary arteries) also occur in the course of the disease. Typical heart complaints include decreased performance, pain in the area of ​​the heart, tightness, and irregular heartbeat.

If the nervous system is affected, the symptoms depend on the location of the inflammatory changes: they can range from sensory disturbances, misconduct and different paralysis to cramps or speech disorders.

In addition to frequently observed symptoms such as muscle and joint pain, the gastrointestinal tract may also be involved in some patients, including vomiting, diarrhea and colic.

Cause of the inflammation still unclear

The causes of panarteritis nodosa have not yet been fully elucidated, presumably various factors work together in the development of the disease. A viral infection often precedes it. Antibodies against hepatitis B can be detected in the blood in 40 percent of patients. According to current ideas, characteristic immune complexes are formed as a result of the infection, which for example consist of virus components, antibodies against the virus and other factors. These complexes are deposited in the small and medium-sized blood vessels and cause inflammation here.

Diagnosis of panarteritis nodosa

Since the infestation of internal organs in particular can have serious consequences, the vascular disease must be recognized as early as possible and treated by an expert in a qualified manner.

Some laboratory findings can provide non-specific indications of the inflammation, such as increases in the so-called acute phase proteins (CRP) and the blood sedimentation rate (BSG). The suspicion can be confirmed by examining the tissue of infected organs (kidney or muscle biopsy). The visual representation of the vessels (angiography) also helps to make the diagnosis of panarteritis nodosa.

Based on the results, however, a number of other diseases, some of which are associated with similar findings (rheumatoid arthritis, systemic lupus erythematosus), must be ruled out before the diagnosis is considered sufficiently reliable.

Treatment of inflammation

The treatment of panarteritis nodosa nowadays initially consists of a high-dose treatment with glucocorticoids, which usually contributes significantly to the improvement of the disease. If the effect is insufficient or a long-term high-dose glucocorticoid therapy is necessary, additional influencing of the immune system with active substances such as cyclophosphamide may be indicated.

This form of combination treatment has significantly improved the prognosis of patients with panarteritis nodosa in recent years. If a viral infection can be detected, a combination of blood purification (plasmapheresis) and antiviral therapy (e.g. with interferon alpha) may also be necessary.

Proper nutrition for rheumatism

Proper nutrition for rheumatism