title: Polyarteritis nodosa in north India: clinical manifestations and outcomes.
abstract: OBJECTIVE
  There has been a significant decrease in the number of published reports of classical polyarteritis nodosa (PAN) in the post-Chapel Hill consensus conference (CHCC) nomenclature era with only two series published from Asia. We report a case series of PAN from north India.
  
  
  METHODS
  A retrospective study of all patients diagnosed to have PAN according to American College of Rheumatology criteria/CHCC nomenclature. The details of clinical presentation, investigation findings, treatment details and outcomes were noted from the records. These findings between the hepatitis B positive and negative groups were compared.
  
  
  RESULTS
  Twenty-seven patients (20 male, seven female) were diagnosed as having PAN, out of which seven (25.9%) were hepatitis B surface antigen positive. Nervous system involvement was most common with 24 patients (88.9%) having mononeuritis multiplex. Weight loss was present in 20 (74%), fever in 14 (51.9%), renal involvement in 16 (59.3%), cutaneous in nine (33.3%), peripheral gangrene in eight (29.6%), gastrointestinal (GI) involvement in eight (29.6%), testicular pain in 6/20 (30%) and cardiac involvement in four (14.8%). Twenty-three (85.2%) patients recovered, three died (11.1%) and one was lost to follow-up. Median follow-up duration was 37 (interquartile range 22.00-69.75) months. The cumulative survival was 114.16 months (95% CI: 98.27-129.95). There was no significant difference in five factor score (FFS) or revised FFS between those patients who died and those who survived (P = 0.248, 0.894, respectively). Hepatitis B-related PAN had a lower FFS compared to non-hepatitis B-related PAN (P = 0.039). No other significant differences were noted between the two groups.
  
  
  CONCLUSIONS
  In comparison to classic PAN in other populations, classic PAN in north India is associated with higher neurological involvement and lower GI involvement.
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Aman
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Benzeeta
authors.initials: B
authors.lastname: Pinto
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Aadhaar
authors.initials: A
authors.lastname: Dhooria
authors.affiliation: Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Rathi
authors.affiliation: Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manphool
authors.initials: M
authors.lastname: Singhal
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kusum
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Parkash
authors.affiliation: Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Modi
authors.affiliation: Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vijayvergiya
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ritambhra
authors.initials: R
authors.lastname: Nada
authors.affiliation: Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ranjana Walkar
authors.initials: RW
authors.lastname: Minz
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
mesh_terms: D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology; D010488:Polyarteritis Nodosa / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: hepatitis B; medium vessel vasculitis; polyarteritis nodosa