In children, cutaneous PAN is frequently associated with streptococcal infections, and positive streptococcal serology is included in the diagnostic criteria. Diagnosis
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 proteinA 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.
The most serious associated conditions generally involve the kidneys and gastrointestinal tract. A fatal course usually involves gastrointestinal bleeding, infection, myocardial infarction, and/or kidney failure.In case of remission, about 60% experience relapse within five years. In cases caused by hepatitis B virus, however, recurrence rate is only around 6%. Epidemiology
The condition affects adults more frequently than children and males more frequently than females. Most cases occur between the ages of 40 and 60. Polyarteritis nodosa is more common in people with hepatitis B infection. History
The medical eponyms Kussmaul disease or Kussmaul-Maier disease reflect the seminal description of the disease in the medical literature by Adolph Kussmaul and Rudolf Robert Maier. Culture
In the 1956 American film Bigger Than Life, the protagonist character played by James Mason is diagnosed with polyarteritis nodosa after experiencing excruciating chest pain and is treated with cortisone. References


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