[Periarteritis nodosa: experience of medecine interne]

ABSTRACT

Periartritis nodosa is a rare necrotic type of systemic vasculitis [angiitis] characterized by a multivisceral affection. Diagnosis is essentially histological. The prognosis has been improved, as a result of the therapeutic progress and the early management of this disease in the specialized centers. We report the experience of the internal medicine unit in the management of this disease depending on the new therapeutic strategies. It is a retrospective study carried out in the internal medicine unit of Ibn Sina hospital of Rabat through a period of 16 years between 1987 and 2003 responding to the clinico-biological criteria of the American College of Rheumatology [ACR] 1990- A series of twenty four cases 12 male and 12 female aged between 17 and 74 years with an age average of 45 years. Several parameters were evaluated clinical manifistations, biological! [sedimentation rate-blood picture creatininemia], bacteriologically [B-C] serology], electromyographical and mainly neuromascular and or cutenous biopsy which assures the certitude of the diagnosis and also therapeutically [evaluation of the treatment]. Neuromuscular and or cutaneous biopsy showed lesions in favour of periarteritis nodosa in 12 patients, the other patients diagnosis was made according to the ACR criteria. As for the treatment, all patients were put under corticosteroid therapy, four severe form were treated by an association of cyclophosphamide and corticoides. Evolution was favourable in 15 patients, with recurrence in 3 cases, death of one case and 5 other patients were lost of sight. The prognosis of periartitis nodosa can be radically modified by the early diagnosis in the specialized centers