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Internal illnesses. Periarteritis nodosa (lecture notes)

Lecture notes, cheat sheets

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LECTURE No. 43. Nodular periarteritis

Periarteritis nodosa is a systemic necrotizing vasculitis of the arteries of medium and small caliber with the formation of vascular aneurysms and secondary damage to organs and systems.

Men are predominantly ill.

Predisposing factors. Risk factors are drug intolerance, hypersensitivity to food, household and professional influences, cooling and insolation, a history of allergic diseases, arthralgia, myalgia, genetic predisposition to allergic and systemic diseases.

Clinic. The main syndromes of the disease are asthenovegetative (weight loss, undulating fever with high temperatures that do not decrease under the influence of antibiotics, weakness, adynamia), cardiac (coronary insufficiency syndrome, heart attacks are possible), hypertensive (arterial hypertension), pulmonary (pneumonitis, asthmatic syndrome), abdominal (abdominal pain, dyspepsia, bleeding), hepatolienal (more often the liver increases), nephrotic (nephritis, nephrosclerosis with typical clinical manifestations), neurological (polyneuritis), trophic changes (subcutaneous nodules), articular (polyarthralgia), Wegener's syndrome (triad : rhinitis, sinusitis, followed by ulceration of the bones and cartilage of the nose; pulmonary vasculitis; kidney damage with the development of failure).

Course options: acute, subacute, chronically recurrent.

The diagnostic criteria are kidney damage with arterial hypertension, typical abdominal syndrome, combined with dyspeptic disorders, pneumonitis or bronchial asthma with high eosinophilia, cardiac syndrome in the form of coronaritis, polyneuritis.

Three out of five criteria are required for diagnosis.

Additional diagnostic study. Examination algorithm as in systemic connective tissue diseases.

Table 8. Clinical and morphological signs of individual nosological forms of systemic vasculitis (according to E. N. Semenkova, 1988)

Differential diagnostics. Should be carried out with systemic connective tissue diseases, infectious diseases, bacterial endocarditis, appendicitis, intestinal obstruction, ulcer perforation, hemoblastoses (Table 8).

Treatment. Hormone therapy is carried out (prednisolone 30-40 mg for 1-2 months, followed by a dose reduction to a maintenance dose of 10-15 mg, complications may develop - steroid vasculitis), a combination of glucocorticoids with cyclophosphamide and azathioprine - up to several years. Heparin, trental, curantyl (improvement of blood rheological parameters), plasmapheresis, hemosorption up to 5-6 sessions are also used. Physiotherapy procedures are contraindicated. Symptomatic treatment is carried out.

Forecast. The prognosis is unfavorable.

Author: Myshkina A.A.

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