Polyarteritis.
Last updated Monday, December 27, 2004
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Management and treatment
Treatment
The treatment of PAN is directed at stopping the inflammation that is
narrowing the blood vessels. If treatment is started early enough in
the disease, normal blood flow can be restored to the involved tissues
and organs, and irreversible damage often can be prevented.Medications
Corticosteroids,
such as cortisone, usually are prescribed first because they work
quickly and are the most powerful anti-inflammatory drugs available. If
you have a mild amount of inflammation, low doses of corticosteroids
may be sufficient, but if the PAN is severe, high doses may be needed
for several months to control the inflammation. Unfortunately, high
doses taken over a period of months can produce serious side effects
such as easy bruising, osteoporosis
(thinning of the bones that can lead to fractures), cataracts, weight
gain, a round face, high blood pressure, and susceptibility to
infections.
A second type of drug called an immunosuppressive is often prescribed
in addition to corticosteroids. As the name suggests, immunosuppressive
drugs suppress the immune system, which controls the inflammation. In
some situations, immunosuppressive drugs allow the dose of
corticosteroids to be reduced and eventually stopped once the disease
is controlled. Cyclophosphamide (Cytoxan) and azathioprine (Imuran) are
the immunosuppressive drugs most commonly used to treat PAN, but others
also are prescribed. Like corticosteroids, immunosuppressive drugs can
cause serious side effects including a susceptibility to infections,
anemia and other blood abnormalities, nausea and vomiting hair loss,
skin rash, kidney and bladder problems, and sterility. If you are
taking cyclophosphamide, it is important to drink a lot of fluids (at
least three liters or quarts of water a day) to prevent bladder
irritation.
As long as you are taking either corticosteroids or
immunosuppressive drugs, your doctor will monitor you closely for signs
of problems. Blood tests will be necessary to detect low blood cell
counts if you are taking immunosuppressives. It is important that you
see your doctor regularly. Between these scheduled visits, call your
doctor if symptoms of infection (such as fever) or other problems
occur.
Fortunately, most cases of PAN now are diagnosed before severe or
irreversible organ damage has occurred. High doses of corticosteroids
can prevent severe organ damage, and immunosuppressive drugs can keep
the disease under control while the corticosteroids are gradually
tapered. Corticosteroids may be necessary for only three to six months.
Immunosuppressive drugs may be needed for several years. Once the
disease is under control, the dose is tapered very slowly while the
doctor watches for unexpected flare-ups. If a flare-up occurs, it may
be necessary to start high doses of corticosteroids again and to
increase the dose of the immunosuppressive drug.
It is very important for you and your family
to be aware of the symptoms of PAN as well as the side effects of
corticosteroids and immunosuppressive drugs. Being well-informed is one
of the most important factors in controlling your disease.
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