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ORIGINAL ARTICLE
Year : 2006  |  Volume : 1  |  Issue : 3  |  Page : 99-106

Twenty-three patients with cutaneous polyarteritis nodosa (C-PAN)— do rheumatologists see a more severe form of the disease?


1 A&R Clinic for Arthritis and Rheumatism' and ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India
2 Jaipur Hospital, Lal Kothi, Jaipur, India
3 Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
A N Malaviya
A&R Clinic for Arthritis and Rheumatism' and ISIC Superspeciality Hospital, Vasant Kunj, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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Objectives: To describe the characteristic features of ulcerative subset of cutaneous polyarteritis nodosa (C-PAN) and its response to therapeutic interventions. Methods: Twenty-three biopsy proven cases of C-PAN were treated and followed up for one year or more. Results: A median follow-up of 2 years (range 1 to 16 years) was obtained. Median age and disease duration at recruitment were 35 years and 5 years, respectively. All patients showed irregular chronic waxing and waning, painful and tender nodulo-ulcerative and/or vesiculobullous lesions on the lower leg, periankle area, and/or dorsum of feet. The lesions were bilateral but asymmetrical in severity. Objective joint disease was seen in approximately one-third of patients, mainly in the ankle and occasionally in the joints of the mid-foot with severe destructive disease in 2 patients. Significant neuralgic pains, neuropathy or mononeuritis multiplex were seen in approximately 40% of the patients. Systemic disease with constitutional symptoms and organ involvement was not seen in any patient. Raised erythrocyte sedimentation rate was seen in approximately 40% of the patients. Other laboratory investiga- tions were unremarkable. Different modalities of treatment gave disappointing results; only about 20% patients achieved complete remission and could be successfully weaned off all medicines. A majority of patients continued to follow a fluctuating course with healing and reappearance of ulcerative lesions and gradually progressive scar- ring. Severe aggressive scarring and disfigurement was seen in one patient who was completely unresponsive to any form of treatment. Conclusion: This study confirms that the ulcerative subset of C-PAN is a more aggressive disease with unsatisfac- tory response to standard therapeutic interventions.


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