Clinical features of polyarteritis nodosa

People with polyarteritis nodosa present with prominent systemic features, such as fever, anorexia, weight loss, myalgia and arthralgia, and specific organ or tissue features. The most common clinical features of polyarteritis nodosa include:

• skin involvement—cutaneous or subcutaneous nodules, palpable purpura, livedo reticularis¹, skin infarction
• peripheral polyneuropathy—sudden onset of pain and paraesthesia progressing to a motor deficit
• intestinal and liver ischaemia—abdominal pain, visceral infarction, intra-abdominal haemorrhage, abnormal liver biochemistry
• kidney impairment—ischaemic nephropathy and malignant hypertension are associated with renal artery disease; glomeruli are rarely affected; end-stage chronic kidney disease can occur.

Polyarteritis nodosa can be associated with hepatitis B and C infections; investigate all people for viral hepatitis because antiviral drugs may be required; see Investigations for polyarteritis nodosa.