Polyarteritis nodosa in north India: clinical manifestations and outcomes

Objective There has been a significant decrease in the number of published reports of classical polyarteritis nodosa (PAN) in the post‐Chapel Hill consensus conference (CHCC) nomenclature era with only two series published from Asia. We report a case series of PAN from north India. Patients and Meth...

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Published in:International journal of rheumatic diseases 2017-03, Vol.20 (3), p.390-397
Main Authors: Sharma, Aman, Pinto, Benzeeta, Dhooria, Aadhaar, Rathi, Manish, Singhal, Manphool, Dhir, Varun, Sharma, Kusum, Parkash, Mahesh, Modi, Manish, Vijayvergiya, Rajesh, Sinha, Saroj K., Nada, Ritambhra, Minz, Ranjana Walkar, Singh, Surjit
Format: Article
Language:English
Subjects:
Case reports
Female
Fever
Gangrene
Gastrointestinal Diseases - diagnosis
Gastrointestinal Diseases - epidemiology
Heart diseases
Hepatitis
hepatitis B
Hepatitis B - diagnosis
Hepatitis B - epidemiology
Hepatitis B surface antigen
Humans
India - epidemiology
Kaplan-Meier Estimate
Kidneys
Male
medium vessel vasculitis
Nervous system
Nervous System Diseases - diagnosis
Nervous System Diseases - epidemiology
Nomenclature
Pain
polyarteritis nodosa
Polyarteritis Nodosa - diagnosis
Polyarteritis Nodosa - epidemiology
Polyarteritis Nodosa - mortality
Polyarteritis Nodosa - therapy
Prognosis
Retrospective Studies
Tertiary Care Centers
Time Factors
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Summary:Objective There has been a significant decrease in the number of published reports of classical polyarteritis nodosa (PAN) in the post‐Chapel Hill consensus conference (CHCC) nomenclature era with only two series published from Asia. We report a case series of PAN from north India. Patients and Methods A retrospective study of all patients diagnosed to have PAN according to American College of Rheumatology criteria/CHCC nomenclature. The details of clinical presentation, investigation findings, treatment details and outcomes were noted from the records. These findings between the hepatitis B positive and negative groups were compared. Results Twenty‐seven patients (20 male, seven female) were diagnosed as having PAN, out of which seven (25.9%) were hepatitis B surface antigen positive. Nervous system involvement was most common with 24 patients (88.9%) having mononeuritis multiplex. Weight loss was present in 20 (74%), fever in 14 (51.9%), renal involvement in 16 (59.3%), cutaneous in nine (33.3%), peripheral gangrene in eight (29.6%), gastrointestinal (GI) involvement in eight (29.6%), testicular pain in 6/20 (30%) and cardiac involvement in four (14.8%). Twenty‐three (85.2%) patients recovered, three died (11.1%) and one was lost to follow‐up. Median follow‐up duration was 37 (interquartile range 22.00–69.75) months. The cumulative survival was 114.16 months (95% CI: 98.27–129.95). There was no significant difference in five factor score (FFS) or revised FFS between those patients who died and those who survived (P = 0.248, 0.894, respectively). Hepatitis B‐related PAN had a lower FFS compared to non‐hepatitis B‐related PAN (P = 0.039). No other significant differences were noted between the two groups. Conclusion In comparison to classic PAN in other populations, classic PAN in north India is associated with higher neurological involvement and lower GI involvement.
ISSN:1756-1841
1756-185X
DOI:10.1111/1756-185X.12954