Master the board step 3

Rheumatology
Polyarteritis Nodosa (PAN)
PAN has all of the features of vasculitis described above. What is different
enough about PAN to allow you to establish the diagnosis is:
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Abdominal pain (65 percent)
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Renal involvement (65 percent)
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Testicular involvement (35 percent)
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Pericarditis (35 percent)
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Hypertension (50 percent)
Diagnostic Testing
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Best initial test: Angiography of abdominal vessels
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Most accurate test: Biopsy (of skin, muscle, or sural nerve)
CCS Tip: There is no good blood test for PAN.
Treatment
Therapy is with prednisone and cyclophosphamide.
PAN does not affect the
lungs.
Hepatitis B surface
antigen is found in 30
percent of patients with
PAN.
Wegener’s Granulomatosis
This disorder, like PAN, can affect the majority of the body. However, look for
upper and lower respiratory findings and c-ANCA.
The most accurate test is biopsy. Treatment is with prednisone and cyclophosphamide.
• Upper and lower
respiratory findings +
c-ANCA = Wegener’s
Churg-Strauss
Although Churg-Strauss can affect any organ in the body, the key to recognizing
it is that it involves vasculitis, eosinophilia, and asthma. Although the
p-ANCA and anti-myeloperoxidase can be positive, too, these findings are not
as uniquely suggestive as the presence of eosinophilia and asthma.
• Vasculitis + Eosinophilia +
Asthma = Churg-Strauss
Biopsy is the most accurate test. There is an excellent response to steroids.
Temporal Arteritis
Temporal arteritis is a type of giant cell arteritis. It is related to polymyalgia
rheumatica. Fever, weight loss, malaise, and fatigue can be present, as they
are in all forms of vasculitis.
The most accurate test is a biopsy.
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