Definition
Polyarteritis nodosa is a serious inflammatory blood vessel disease. The small and medium-sized arteries become swollen and damaged.
Causes
Arteries are the blood vessels that carry oxygen-rich blood to organs and tissues. The cause of polyarteritis nodosa is unknown. The condition occurs when certain immune cells attack the affected arteries. The tissues that are fed by the affected arteries do not get the oxygen and nourishment they need. Damage occurs as a result.
More adults than children get this disease.
People with active hepatitis B or hepatitis C may develop this disease.
Symptoms
Symptoms are caused by damage to affected organs. The skin, joints, muscles, gastrointestinal tract, heart, kidneys, and nervous system are often affected.
Symptoms include:
- Abdominal pain
- Decreased appetite
- Fatigue
- Fever
- Joint aches
- Muscle aches
- Unintentional weight loss
- Weakness
- Testicular swelling and pain
If nerves are affected, you may have numbness, pain, burning, and weakness. Damage to the nervous system may cause strokes or seizures.
Exams and Tests
No specific lab tests are available to diagnose polyarteritis nodosa. There are a number of disorders that have features similar to polyarteritis nodosa. These are known as "mimics."
You will have a complete physical exam.
Lab tests that can help make the diagnosis and check for disease mimics include:
- Complete blood count (CBC) with differential, serum creatinine, tests for hepatitis B and C, and urinalysis
- Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- Serum protein electrophoresis
- Serum complement levels
- HIV test
- Hepatitis B and hepatitis C tests
- Cryoglobulins
- Anti-phospholipid antibodies
- Blood cultures
- Other blood tests will be done to check for similar conditions, such as systemic lupus erythematosus (ANA) or granulomatosis with polyangiitis (ANCA)
- Arteriogram
- Tissue biopsy
Treatment
Treatment involves medicines to suppress inflammation and the immune system. These may include steroids, such as prednisone. Similar medicines, such as azathioprine, methotrexate, or mycophenolate that allow for reducing the dose of steroids are often used as well. Cyclophosphamide is used in severe cases.
For polyarteritis nodosa related to hepatitis, treatment may involve plasmapheresis and antiviral medicines.
Outlook (Prognosis)
Current treatments with steroids and other medicines that suppress the immune system (such as azathioprine or cyclophosphamide) can improve symptoms and the chance of long-term survival.
The most serious complications most often involve the kidneys and gastrointestinal tract.
Without treatment, the outlook is poor.
Possible Complications
Complications may include:
- Heart attack
- Intestinal necrosis and perforation
- Kidney failure
- Stroke
- Death
When to Contact a Medical Professional
Contact your health care provider if you develop symptoms of this disorder. Early diagnosis and treatment may improve the chance of a good outcome.
Prevention
There is no known prevention. However, early treatment can prevent some damage and symptoms.
References
Ayaz NA, Ozen S. Polyarteritis nodosa. In: Firestein GS, McInnes IB, Koretzky GA, Mikuls TR, Neogi T, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 91.
James WD. Cutaneous vascular diseases. In: James WD, ed. Andrews' Diseases of the Skin: Clinical Dermatology. 14th ed. Philadelphia, PA: Elsevier; 2026:chap 30.
Stone JH. The systemic vasculitides. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 249.
Version Info
Last reviewed on: 5/9/2024
Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.