Panarteritis Nodosa
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Poliarteritis Nodosa
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German Archive For Clinical Medicine
“Las arterias epicárdicas parecen estar más gruesas y con cordones
nodulares amarillentos”― Kussmaul & Maier, 1866
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German Archive For Clinical Medicine
...periarteritis nodosa
― Kussmaul & Maier, 1866
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German Archive For Clinical Medicine
...poliarteritis nodosa
― Ferrari & Dickinson, 1900
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Epidemiología...
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Poliarteritis nodosaCon y sin compromiso glomerular
Micro poliarteritis nodosaCompromiso glomerular
Poliangeitis microscópicaCompromiso glomerular, p-ANCA
Poliarteritis Nodosa ClásicaInflamación necrotizante que afecta a las arterias medianas, respetando vasos más pequeños y no se asocia a glomerulonefritis
― Chapel Hill Consensus Conference, 1994
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vs ¿?fisiopatología...
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Jejunal Specimen Obtained at Laparotomy From a Patient Who Died of Complications of Mesenteric Ischemia Related to Polyarteritis Nodosa
Compromiso arterial
Respeta aorta y sus ramas
Infiltrado pleomórfico
Necrosis segmentaria
...patología
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Arterial Microaneurysms in Polyarteritis Nodosa
N Engl J Med 355;24, 2006
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Clínica...
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Inicio
Insidioso
D i a g n ó s t i c oretrospectivo
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Fiebre
Característico
Raro como síntoma aislado
Características variables
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Síntomas constitucionales
Malestar general
Fatiga
Pérdida de peso
Mialgias
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Artralgias
50% de los pacientes
Rodillas
Tobillos
Codos
Muñecas
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Signos cutáneosNódulos Úlceras Isquemia digital Livedo reticularis
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Mononeuritis multipleSural
Peroneal
Radial
Ulnar
60%M o n o n e u r i t i s
Compromiso
Asimétrico
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Gastrointestinal
Dolor postprandial
Infarto mesentérico
Microaneurismas
50%
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Renal
40%Infartos
HTA renina dependiente
Proteinuria / Hematuria
A n g i o g r a f í a r e n a l
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Taquicardia
Característico
Parches de necrosis miocárdica
ICC
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Otros órganos...
Cerebro
Ojos
Pancreas
Testículos
Ureteres
Mamas
Ovarios
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El único que se salva...
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Serología...
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AN
A
crioglobulinas PCR
VHS
VHB
C3-C4
ANCA
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...Tratamiento
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Cor
tico
ides
Citotóxico
s50%
R e m i s i ó n
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The Five Factor Score (añade 10% mortalidad c/u)
1 Hemorragia gastrointestinal
2 Insuficiencia renal
3 Proteinuria > 1 g/d
4 Compromiso de SNC
5 Cardiopatía
¿Cuando Usar Ciclofosfamida?
Guillevin, Medicine 1996
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John H. Stone
Polyarteritis Nodosa
2002;288(13):1632-1639
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Gracias