Polyarteritis Nodosa (PAN)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

Symptoms of Rheumatoid Arthritis

What are symptoms and signs of polyarteritis nodosa?

Polyarteritis nodosa causes symptoms and signs that are a result of injury to the blood vessels. Therefore, the symptoms and signs depend on which vessels are affected and to what degree. This can lead to organ damage or injury. For example, if blood vessels supplying the nerves or muscles are affected, the nerves or muscles can be damaged. If the blood vessels to the kidneys are affected, kidney damage with blood in the urine can result. Symptoms and signs can include fatigue, weight loss, high blood pressure, muscle pain (myalgia), joint pain (arthralgia), testicular pain, livido reticularis, nerve damage, and abdominal pain.

How is polyarteritis nodosa diagnosed?

The diagnosis is supported by tests that indicate inflammation including elevation of blood sedimentation rate and C-reactive protein. The white blood cell count and platelet count can be elevated, while the red blood count is decreased (anemia). Hepatitis B virus (testing for either antigen or antibody) can be found in 10%-20% of patients with polyarteritis nodosa. Urine testing can show protein and red blood cells in the urine. In patients with nerves affected, nerve conduction tests are abnormal.

The diagnosis of polyarteritis nodosa is confirmed by a biopsy of involved tissue that reveals the inflamed blood vessels (vasculitis). Examples of tissues that are sometimes biopsied include nerves, muscle, kidneys, and bowel. Vasculitis of the bowel and kidneys can often be detected with an angiogram (X-ray testing while contrast "dye" is infused into the blood vessels).

The American College of Rheumatology established criteria for the classification of polyarteritis nodosa in 1990. For classification purposes (to group patients together for medical studies), a patient is said to have polyarteritis nodosa if at least three of the following 10 criteria are present:

  1. Weight loss greater than/equal to 4 kg
  2. Livedo reticularis (a mottled purplish skin discoloration over the extremities or torso)
  3. Testicular pain or tenderness (occasionally, a site biopsied for diagnosis)
  4. Muscle pain, weakness, or leg tenderness
  5. Nerve disease (either single or multiple)
  6. Diastolic blood pressure greater than 90 mm Hg (high blood pressure)
  7. Elevated kidney blood tests (BUN greater than 40 mg/dl or creatinine greater than 1.5 mg/dl)
  8. Hepatitis B virus tests positive (for surface antigen or antibody)
  9. Arteriogram (angiogram) showing the arteries that are dilated (aneurysms) or constricted by the blood vessel inflammation
  10. Biopsy of tissue showing the arteritis (typically inflamed arteries)
Medically Reviewed by a Doctor on 2/5/2016

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