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periarteritis nodosa[¦per·ē‚ärd·ə′rīd·əs nō′dō·sə]
(also called polyarteritis), a systemic disease of small and medium-sized arteries; one of the collagen diseases. In 1866 the German physicians A. Kussmaul and R. Maier provided a detailed clinical and morphological description of the disease and gave it its name, so termed because the affected arteries are dotted with nodules.
Periarteritis nodosa affects mainly middle-aged men. It is caused by a hyperergic reaction of the body to infection, drugs (particularly sulfanilamides and antibiotics), vaccines, and serums. The role of chronic viral infection is now under discussion. The Australia antigen characteristic of infectious hepatitis is found in persons affected with periarteritis nodosa. The available data suggest that a viral antigen and antibodies reacting to it play a role in the injury to the vascular wall. Focal inflammation of the arterial wall begins with fibrinoid necrosis, that is, inflammatory infiltration around a blood vessel. Scar tissue is formed and the vascular wall becomes dilated, resulting in the formation of an aneurysm. The vascular wall finally ruptures, causing hemorrhaging into the tissues. Intravascular thromboses cause infarction of tissues that receive their blood supply from the affected vessels.
The onset of periarteritis nodosa is sudden or gradual, and the disease’s course is often variable. Symptoms include fever, exhaustion, and pain in various parts of the body. Several syndromes are often combined, owing to disseminated lesions of the arteries of different organs. Involvement of the heart’s blood vessels is manifested by symptoms of angina pectoris and may result in myocardial infarction. Affectation of the bronchial and pulmonary blood vessels is associated with bronchitis and attacks of bronchial asthma, and affectation of the kidneys, with hypertension, changes in the fundus oculi, and the appearance of albumin and red blood cells in the urine. Involvement of the peripheral nervous system is associated with asymmetrical polyneuritis, and involvement of the mésenteric blood vessels, with symptoms of acute abdomen. Early diagnosis and treatment with corticosteroids and cytostatics sometimes arrests the disease and induces remission.
REFERENCESTeplov, I. T. Klinika bolezni Kussmaul ’-Malera. Leningrad, 1941.
Volevich, R. V. Uzelkovyiperiarteriit. Moscow, 1960.
Tareev, E. M. Kollagenozy. Moscow, 1965.
Vorob’ev, I. V., and V. E. Liubomudrov. Uzelkovyi periarteriit. Moscow, 1973.
V. A. NASONOVA