How is polyarteritis nodosa treated?

Indications for hospitalization for polyarteritis nodosa

Indications for hospitalization are the onset, exacerbation of the disease, and examination to determine the treatment protocol during remission.

Indications for consultation with other specialists

• Neurologist, ophthalmologist - high blood pressure, symptoms of damage to the nervous system.
• Surgeon - severe abdominal syndrome; dry gangrene of the fingers.
• ENT, dentist - pathology of ENT organs, need for dental sanitation.

Non-drug treatment of polyarteritis nodosa

During the acute period, hospitalization, bed rest, and diet No. 5 are mandatory.

Drug treatment of polyarteritis nodosa

Drug treatment of polyarteritis nodosa is carried out taking into account the phase of the disease, clinical form, nature of the main clinical syndromes, and severity. It includes pathogenetic and symptomatic therapy.

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Pathogenetic therapy of polyarteritis nodosa

Its nature and duration depend on the localization of the vascular lesion and its severity. The basis of pathogenetic therapy is glucocorticosteroids. In case of high activity, a cytostatic (cyclophosphamide) is prescribed. In juvenile polyarteritis, the maximum daily dose of prednisolone is 1 mg/kg. Patients with severe thromboangiitis syndrome undergo 3-5 plasmapheresis sessions, daily synchronized with pulse therapy with methylprednisolone (10-15 mg/kg). Patients receive the maximum dose of prednisolone for 4-6 weeks or more until the disappearance of clinical signs of activity and improvement of laboratory parameters. Then the daily dose is reduced by 1.25-2.5 mg every 5-14 days to 5-10 mg per day. Maintenance treatment is carried out for at least 2 years.

In case of high arterial hypertension, which is an obstacle to the administration of glucocorticosteroids in an adequate dose, cytostatics (cyclophosphamide) are used in combination with low doses of prednisolone (0.2-0.3 mg/kg per day) at a rate of 2-3 mg/kg per day, after a month the dose is reduced by 2 times and treatment is continued until remission. A modern alternative to oral cyclophosphamide is intermittent therapy - intravenously 12-15 mg/kg once a month for a year, then once every 3 months and after another year - discontinuation of treatment.

Anticoagulants are used to improve blood circulation. Sodium heparin is administered to patients with thromboangiitis syndrome and internal organ infarctions 3-4 times a day subcutaneously or intravenously at a daily dose of 200-300 U/kg under the control of coagulogram parameters. Treatment with sodium heparin is carried out until clinical improvement. To reduce tissue ischemia, antiplatelet agents are prescribed: dipyridamole (curantil), pentoxifylline (trental), ticlopidine (ticlid) and other vascular drugs.

In classical polyarteritis nodosa, prednisolone is prescribed in a short course (not prescribed at all in malignant arterial hypertension), basic treatment is cyclophosphamide therapy; in case of severe (crisis) course, plasmapheresis is additionally performed (synchronously with pulse therapy).

Symptomatic treatment of polyarteritis nodosa

In case of severe hyperesthesia and pain in the joints and muscles, painkillers are used; in case of arterial hypertension, antihypertensive agents are used. Antibiotics are prescribed in case of intercurrent infections at the onset or during the disease, or in the presence of foci of infection. Long-term use of glucocorticosteroids and cytostatics entails the development of side effects that require appropriate treatment. When treating with cytostatics, side effects include agranulocytosis, hepato- and nephrotoxicity, infectious complications; when treating with glucocorticosteroids, drug-induced Itsenko-Cushing's syndrome, osteoporosis, delayed linear growth, and infectious complications. Calcium carbonate, calcitonin (miacalcic), and alfacalcidol are used to prevent and treat osteopenia and osteoporosis. Infectious complications develop during treatment with both glucocorticosteroids and cytostatics. They not only limit the adequacy of basic treatment, but also maintain the activity of the disease, which leads to prolongation of treatment and an increase in its side effects. An effective method of treatment and prevention of infectious complications is the use of IVIG. Indications for their use are high activity of the pathological process in combination with infection or infectious complications against the background of anti-inflammatory immunosuppressive therapy. The course of treatment is from 1 to 5 intravenous infusions, the course dose of standard or enriched IVIG is 200-1000 mg / kg.

Surgical treatment of polyarteritis nodosa

Surgical treatment is indicated in the development of "acute abdomen" symptoms in patients with abdominal syndrome. In digital gangrene - necrectomy. During the remission period, tonsillectomy is performed in patients with juvenile periarteritis, recurring due to chronic tonsillitis.

Forecast

The outcome of the disease may be a relative or complete remission for a period of 4 to 10 years or more, the 10-year survival rate of patients with juvenile periarteritis approaches 100%. A more unfavorable prognosis is for classic nodular periarteritis associated with viral hepatitis B and occurring with arterial hypertension syndrome. Along with possible long-term remission, a fatal outcome may be observed in severe cases. The causes of death are peritonitis, cerebral hemorrhage or edema with herniation syndrome, and less often, chronic renal failure.