How is polyarteritis nodosa treated?

Indications for admission to nodular polyarteritis

Indications for hospitalization are debut, exacerbation of the disease, examination to determine the protocol of treatment in remission.

Indications for consultation of other specialists

• Neuropathologist, ophthalmologist - a high level of arterial pressure, symptoms of damage to the nervous system.
• The surgeon is a pronounced abdominal syndrome; dry gangrene of the fingers of the limbs.
• ENT, dentist - pathology of ENT organs, necessity of teeth sanitation.

Non-pharmacological treatment of nodular polyarteritis

In the acute period, mandatory hospitalization, bed rest, diet number 5.

Drug treatment of nodular polyarteritis

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

[1], [2], [3], [4], [5]

Pathogenetic therapy of nodular polyarteritis

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

With high arterial hypertension, which serves as an obstacle to the appointment of glucocorticosteroids in an adequate dose, cytotoxic agents (cyclophosphamide) are used in combination with low doses of prednisolone (0.2-0.3 mg / kg / day) at a dose of 2-3 mg / kg per day, a month later, the dose is reduced by 2 times and continues treatment until the onset of remission. A modern alternative to taking cyclophosphamide inside is intermittent therapy - intravenously 12-15 mg / kg once a month for a year, then once every 3 months and after another year - treatment cancellation.

In order to improve blood circulation, anticoagulants are used. Sodium heparin is administered to patients with thrombangiotic syndrome and infarctions of internal organs 3-4 times a day subcutaneously or intravenously at a daily dose of 200-300 U / kg under the control of coagulogram indices. Treatment with heparin sodium is performed prior to clinical improvement. To reduce tissue ischemia, antiplatelet agents are prescribed: dipyridamole (quarantil), pentoxifylline (trental), ticlopidine (ticlid), and other vascular preparations.

With classic nodular polyarteritis, prednisolone is prescribed a short course (for malignant hypertension is not prescribed at all), the basic treatment is with cyclophosphamide; In the case of severe (crisis) flow, additional plasmapheresis is carried out (synchronously with pulse therapy).

Symptomatic treatment of nodular polyarteritis

With pronounced hyperesthesias and pains in the joints, muscles, anesthetics are used, with arterial hypertension - hypotensive drugs. Antibiotics are prescribed in the case of intercurrent infection in the opening or on the background of the disease, the presence of foci of infection. Long-term use of glucocorticosteroids and cytotoxic agents leads to the development of side effects that require appropriate treatment. In the treatment of cytostatics, side effects - agranulocytosis, hepato- and nephrotoxicity, infectious complications; in the treatment of glucocorticosteroids - medicinal syndrome of Itenko-Cushing, osteoporosis, delay of linear growth, infectious complications. For the prevention and treatment of osteopenia and osteoporosis, calcium carbonate, calcitonin (miacalcic) and alfacalcidol are used. Infectious complications develop in the treatment of both glucocorticosteroids and cytostatics. They not only limit the adequacy of basic treatment, but also support the activity of the disease, which leads to lengthening of treatment and the growth of its side effects. An effective method of treatment and prevention of infectious complications is the use of IVIG. Indications for their purpose 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 nodular polyarteritis

Surgical treatment is indicated in the development of symptoms of the "acute abdomen" in patients with abdominal syndrome. With finger gangrene - necrotomy. During the remission period, patients with juvenile periarteritis recurring in connection with chronic tonsillitis are given tonsillectomy.

Forecast

The outcome of the disease may be a relative or complete remission for 4 to 10 years or more, a 10-year survival of patients with juvenile periarteritis approaches 100%. The more unfavorable prognosis is the classic periarteritis nodular associated with viral hepatitis B and flowing with the syndrome of hypertension. Along with the possible long-term remission in severe cases, there may be a fatal outcome. Causes of death - peritonitis, hemorrhages in the brain or its edema with a wedge syndrome, less often - chronic renal failure.

[6]