Clinical characteristics of polyarteritis nodosa patients with acromelic gangrene

Abstract

Objective To evaluate the clinical characterisitics of polyarteritis nodosa(PAN) patients with acromelic gangrene, and to improve the understanding of this disease by clinicians. Methods The clin-ical and laboratory data of PAN patients with acromelic gangrene admitted to Peking Union Medical College Hospital(PUMCH) between November 1986 to October 2016 were collected and summarized. According to the ratio of 1∶2, PAN patients without acromelic gangrene during the same period were randomly selected and compared with patients with acromelic gangrene. The comparison of the demographic data, system involvement, laboratory and other auxiliary examination results, the treatment were included in this study. All data were an-alyzed by SPSS 19.0 statistical software. T test, Mann Whitney U test, χ2 test were used for statistical analyses. Results Among 204 PAN patients admitted to PUMCH during this period, 22 cases were complicated with gangrenes. In PAN patients with gangrenes,-male/female ratio was 4.5/1, the mean age was (43±19) years, and the disease duration (from onset of disease to gangrene) was 3.5 months (ranged from 1 week to 20 years). Simple finger gangrenes occurred in 7 cases(32%), simple toe gangrenes in 8 cases (36%), both gangrenes in 7 cases (32%). In the involvements of limb arteries, 15 cases(68%) were posterior tibial artery involvement, 12 cases(55%) were anterior tibial artery involvement, 10 cases(45%) were radial artery involvement, 7 cases (32%) were ulnar artery involvement, 5 cases (23%) were peroneal artery involvement, 5 cases (23%) were superficial femoral artery involvement, 4 cases(18%) were dorsal foot artery involvement, 3 cases (14%) were popliteal artery involvement,1 case (5%) was anterior interosseous artery involvement. There were significant difference in PAN patients with and without acromelic gangrene as patients with acromelic gangrene were more prone to arthritis/pain (45% vs 2%; χ2=16.71, P<0.01), new-onset hypertension (41% vs 7%; χ2=9.28, P<0.01), intestinal bleeding/perforation (41% vs 14%; χ2=6.21, P=0.01), increased eosinophils (55% vs 7%; χ2=19.02, P<0.01), artery (91% vs 27%; χ2=23.78, P<0.01) involvement in extremities, head and neck (41% vs 18%; χ2=3.96, P=0.05), arteriovenous thrombosis (27% vs 2%; χ2=7.21, P=0.007), glucocorticoid pulse therapy (73% vs 14%; χ2=23.05, P<0.01). Conclusion PAN patients with acromelic gangrene have significant increase of eosinophils and widespread internal organ ischemia. Aggressive treatment should be taken in these patients. Key words: Polyarteritis nodosa; Gangrene; Clinical characteristics