page_title: Polyarteritis nodosa
section_title: Diagnosis
hierarchical_section_title: Polyarteritis nodosa / Diagnosis
caption_attribution_description: English: A sterling silver Catholic rosary. Français&#160;: Un rosaire catholique en argent fin.
context_page_description: Polyarteritis nodosa, is a systemic necrotizing inflammation of blood vessels affecting medium-sized muscular arteries, typically involving the arteries of the kidneys and other internal organs but generally sparing the lungs' circulation. Polyarteritis nodosa may be present in infants. In polyarteritis nodosa, small aneurysms are strung like the beads of a rosary, therefore making "rosary sign" an important diagnostic feature of the vasculitis. PAN is sometimes associated with infection by the hepatitis B or hepatitis C virus.
  PAN is a rare disease. With treatment, five-year survival is 80%; without treatment, five-year survival is 13%. Death is often a consequence of kidney failure, myocardial infarction, or stroke.
context_section_description: No specific lab tests exist for diagnosing polyarteritis nodosa. Diagnosis is generally based on the physical examination and a few laboratory studies that help confirm the diagnosis:
  CBC (may demonstrate an elevated white blood count)
  ESR (elevated)
  Perinuclear pattern of antineutrophil cytoplasmic antibodies (p-ANCA) - not associated with "classic" polyarteritis nodosa, but is present in a form of the disease affecting smaller blood vessels, known as microscopic polyangiitis or leukocytoclastic angiitis
  Tissue biopsy (reveals inflammation in small arteries, called arteritis)
  Elevated C-reactive protein
  A patient is said to have polyarteritis nodosa if he or she has three of the 10 signs known as the 1990 American College of Rheumatology (ACR) criteria, when a radiographic or pathological diagnosis of vasculitis is made:
  Weight loss greater than/equal to 4.5 kg
  Livedo reticularis (a mottled purplish skin discoloration over the extremities or torso)
  Testicular pain or tenderness (occasionally, a site biopsied for diagnosis)
  Muscle pain, weakness, or leg tenderness
  Nerve disease (either single or multiple)
  Diastolic blood pressure greater than 90 mmHg (high blood pressure)
  Elevated kidney blood tests (BUN greater than 40 mg/dL or creatinine greater than 1.5 mg/dL)
  Hepatitis B (not C) virus tests positive (for surface antigen or antibody)
  Arteriogram (angiogram) showing the arteries that are dilated (aneurysms) or constricted by the blood vessel inflammation
  Biopsy of tissue showing the arteritis (typically inflamed arteries): The sural nerve is a frequent location for the biopsy.
  In polyarteritis nodosa, small aneurysms are strung like the beads of a rosary, therefore making "rosary sign" an important diagnostic feature of the vasculitis. The 1990 ACR criteria were designed for classification purposes only. Nevertheless, their good discriminatory performances, indicated by the initial ACR analysis, suggested their potential usefulness for diagnostic purposes as well. Subsequent studies did not confirm their diagnostic utility, demonstrating a significant dependence of their discriminative abilities on the prevalence of the various vasculitides in the analyzed populations. Recently, an original study, combining the analysis of more than 100 items used to describe patients' characteristics in a large sample of vasculitides with a computer simulation technique designed to test the potential diagnostic utility of the various criteria, proposed a set of eight positively or negatively  discriminating items to be used as a screening tool for  diagnosis in patients suspected of systemic vasculitis.
caption: In polyarteritis nodosa, small aneurysms are strung like the beads of a rosary, therefore making "rosary sign" a diagnostic feature of the vasculitis.
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