AB0617 CUTANEOUS POLYARTERITIS NODOSA TREATMENT: A RETROSPECTIVE CASE SERIES
Authors: Mohan Stewart, Ada Lo, Kamran Shojania, Sheila Au, Jan Dutz, Michael Seidman, Jon Chan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cutaneous polyarteritis nodosa (CPAN) is a small-to-medium vessel vasculitis limited to the skin. As it is a rare condition, there is little data available to guide treatment. Previous articles have suggested that colchicine and dapsone be used in mild disease and glucocorticoids in acute flares, with DMARDs such as methotrexate or azathioprine being reserved for moderate to severe disease, or steroid-refractory disease. <h3>Objectives:</h3> Our objective was to review therapeutic regimens used to treat CPAN and to evaluate patient response. <h3>Methods:</h3> A retrospective chart review including records from January 2003 to June 2017 was performed to identify patients with both histologic and clinical features of CPAN. We extracted information regarding patient age, clinical presentation, biopsy results, and response to treatment. <h3>Results:</h3> Thirteen patients were identified who had clinical features of CPAN that were supported by histologic findings on biopsy. The majority of patients were female (92.3%). The average age at diagnosis was 44.9 years and mean duration of follow up was 53 months. All patients had involvement of the lower limbs with the most common cutaneous manifestation being subcutaneous nodules (92.3%), followed by papules (46.2%) and livedo reticularis (30.8%). Eight out of thirteen patients (61.5%) received steroids and three did not experience clinical benefit. Another patient did not respond to prednisone and hydroxychloroquine, but had significant improvement of her symptoms on prednisone and methotrexate. Seven out of nine patients (77.8%) who were treated with methotrexate had a favourable response. Three of those patients responded to methotrexate after failing other therapies such as dapsone, azathioprine, and prednisone. <h3>Conclusion:</h3> In this case series, we found that most patients had a favorable response to methotrexate and thus the role of methotrexate in treating CPAN merits further investigation. As CPAN often has a chronic relapsing and remitting course, initiating methotrexate at the same time as steroid therapy may lower overall lifetime exposure to steroids. <h3>References</h3> [1] Daoud MS, Hutton KP, Gibson LE. Cutaneous periarteritis nodosa: a clinicopathological study of 79 cases. Br J Dermatol. 1997May;136(5):706–13. [2] Ross K, Contreras J, aung-Din D, Lien M. Asymptomatic cutaneous polyarteritis nodosa: treatment options and therapeutic guidelines. Cutis. 2017Aug;100(2):125–8. [3] Maillard H, Szczesniak S, Martin L, Garot D, Machet MC, Machet L, et al. [Cutaneous periarteritis nodosa: diagnostic and therapeutic aspects of 9 cases]. Ann Dermatol Venereol. 1999Feb;126(2):125–9. [4] Khoo BP, Ng SK. Cutaneous polyarteritis nodosa: a case report and literature review. Ann acad Med Singapore. 1998Nov;27(6):868–72. [5] Schartz NEC, alaoui S, Vignon-Pennamen MD, Cordoliani F, Fermand JP, Morel P, et al. Successful treatment in two cases of steroid-dependent cutaneous polyarteritis nodosa with low-dose methotrexate. Dermatology. 2001;203(4):336–8. <h3>Disclosure of interests:</h3> Mohan Stewart: None declared, ada Lo: None declared, Kamran Shojania: None declared, Sheila au: None declared, Jan Dutz: None declared, Michael Seidman: None declared, Jon Chan Grant/research support from: Janssen, UCB, Novartis, Pfizer, Celgene, Consultant for: amgen, Celgene, Eli Lilly, Janssen, amgen, abbvie, Novartis, Pfizer, UCB, Sandoz, Merck,