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Polyarteriitis nodosa

Differenzialdiagnostik und Therapie

Polyarteritis nodosa

Differential diagnostics and therapy

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Zusammenfassung

Die Polyarteriitis nodosa (PAN) ist eine nekrotisierende Vaskulitis mittelgroßer Arterien, die viele unterschiedliche Organe betreffen kann. Das klinische Bild ist hierdurch sehr vielgestaltig. Besonders typisch ist die Beteiligung von Haut, peripherem Nervensystem als Mononeuritis multiplex oder der mesenterialen und renalen Gefäße mit Ausbildung von Stenosen oder Mikroaneurysmen. Etwa ein Drittel der Fälle sind Hepatitis-B-assoziiert. Die Therapie ist abhängig von der Genese der Erkrankung: Die primäre PAN wird immunsuppressiv, die HBV (Hepatitis-B-Virus)-assoziierte PAN mittels antiviraler Therapie und Plasmapherese behandelt. Die Abgrenzung der PAN von anderen Vaskulitiden ist mitunter schwierig und erfordert eine komplexe Differenzialdiagnostik.

Abstract

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium size arteries that may affect various organs. The clinical appearance is very variable. The most common manifestations are of the skin, the peripheral nervous system presenting as mononeuritis multiplex and the mesenteric and renal blood vessels due to the development of stenoses and small aneurysms. Of the cases one third are estimated to be associated with hepatitis B virus (HBV). The therapy depends on the pathogenesis of the disease: primary PAN is treated with immunosuppressants, whereas patients with HBV-related PAN should receive antiviral therapy and plasmapheresis. Differentiating PAN from other forms of vasculitis can be difficult and requires complex differential diagnostics.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.H. Schirmer, K. Holl-Ulrich und F. Moosig geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to J.H. Schirmer.

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Schirmer, J., Holl-Ulrich, K. & Moosig, F. Polyarteriitis nodosa. Z. Rheumatol. 73, 917–927 (2014). https://doi.org/10.1007/s00393-014-1483-z

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