Management overview for polyarteritis nodosa

For a management approach common to most of the systemic vasculitides, including the principles of inducing and maintaining remission of disease, see Management overview for systemic vasculitides.

Polyarteritis nodosa requires specialist management and is treated with a long course of high-dose systemic corticosteroids and other immunomodulatory drugs for corticosteroid-sparing. Use the lowest dose and shortest duration of corticosteroid therapy necessary to control disease and prevent relapse because long-term therapy can cause significant adverse effects. The treatment depends on the organ(s) involved and disease severity.

If polyarteritis nodosa is suspected, discuss urgently with a specialist to determine if immediate intensive induction therapy is required. Rheumatologists strongly encourage direct contact by general practitioners to expedite referral or obtain advice on treatment (eg before starting high-dose systemic corticosteroids). A delay in treatment can result in serious organ-related complications.

People with polyarteritis nodosa associated with hepatitis B or hepatitis C infections should also be treated with antiviral therapy. This is particularly relevant if immunomodulatory drug therapy is being considered, because chronic viral hepatitis can be reactivated. Close monitoring of the viral hepatitis is required.