Polyarteritis Nodosa

What is Polyarteritis Nodosa?

Polyarteritis nodosa is a systemic necrotizing vasculitis, a disease in which the walls of medium-sized arteries become inflamed and damaged.^[1] It can involve almost any organ, so it needs diagnosis and treatment by a physician, usually a rheumatologist.^{[2, 3]}

Common symptoms

Many people first have general symptoms such as weakness, fever and unintended weight loss.^[2] The disease most often affects the skin, the nervous system and the digestive tract.^[2]

Depending on the arteries involved, other signs can include painful skin nodules or ulcers, abdominal pain, numbness or weakness from nerve damage, and high blood pressure from kidney involvement.^{[1, 2]} Serious complications include bleeding or clots in the arteries of the gut, heart, brain and kidneys.^[2] A limited form, cutaneous polyarteritis nodosa, mainly affects the skin but can still cause painful nodules and ulcers.^[1]

Causes and risk factors

The cause is not fully known. The disease was historically linked to hepatitis B virus infection, but that link has become much less common as hepatitis B has declined. Recent research instead links it more often with genetic syndromes and cancer.^[2]

How it is diagnosed and treated conventionally

Diagnosis uses a biopsy that shows vasculitis in medium-sized arteries, and angiography can show multiple small aneurysms in the organs.^[4] Unlike some other types of vasculitis, polyarteritis nodosa is not typically associated with ANCA antibodies.^[1]

Treatment uses high-dose glucocorticoids, combined with immune-suppressing drugs when internal organs are involved or the disease is life-threatening. Maintenance drugs are used once remission is reached.^[4] The 2021 American College of Rheumatology and Vasculitis Foundation guideline supports early treatment of severe disease with cyclophosphamide and glucocorticoids, while limiting long-term exposure to both to reduce toxicity.^[3] Most of its recommendations were conditional because little high-quality evidence exists.^[3]

Why Polyarteritis Nodosa calls for a whole-person approach

Polyarteritis nodosa is a disease of blood vessels, but its effects on a person reach well beyond the vessels. The disease, and the strong drugs used against it, can affect pain, sleep, digestion, mood and energy.

Medical treatment controls the disease. Supportive care here is limited to the problems around it, and only with your rheumatologist's knowledge.

Pain and nerve symptoms

The nervous system is one of the most commonly affected sites, and nerve damage can cause numbness, tingling or weakness.^{[1, 2]} Nerve symptoms need medical assessment first, because they can signal active disease.

Treatment burden

Treatment involves long exposure to glucocorticoids and sometimes cyclophosphamide, and the guideline stresses limiting this exposure because of toxicity.^[3] Nausea, fatigue and sleep problems related to treatment are among the things patients may want help with.

Fatigue and general illness

Fatigue, fever and weight loss are common general symptoms of the disease.^[2] These can persist or recur and are worth reporting to your physician, since they may reflect disease activity.

Stress and coping with a rare disease

Living with a rare, serious disease can bring stress and worry. Stress itself does not cause polyarteritis nodosa, and managing it is a reasonable goal for supportive care.

Acupuncture as supportive care in Polyarteritis Nodosa

What the research shows

A PubMed search found no clinical trials or systematic reviews of acupuncture for polyarteritis nodosa. We cannot say that it helps the disease, and it cannot replace the medicines that control it.

What exists is research in other groups of patients. A network meta-analysis of 33 studies (2,027 participants) in people with chemotherapy-induced nerve damage found acupuncture-related treatments improved symptoms, pain and quality of life compared with usual care or medicines.^[5] A meta-analysis of 38 trials (2,503 patients) found that acupuncture added to usual care may improve control of vomiting after chemotherapy, but the certainty of the evidence was low or very low.^[6] An overview of 51 systematic reviews found acupuncture was reported to help cancer-related pain, fatigue and insomnia, although most of the reviews were of very low quality.^[7]

These were done in people with cancer and chemotherapy, not vasculitis, so the results may not carry over.

How acupuncture may work

No studies explain how acupuncture might act in polyarteritis nodosa. We do not claim that it affects the vessel inflammation or the immune process behind the disease.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course of several visits is followed by reassessment. The aim would be comfort, sleep and coping with symptoms.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[8] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker. Also tell us if you are on high-dose steroids or immune-suppressing drugs, have open skin ulcers or nodules, or have had a recent infection, because needling over affected skin should be avoided.

Ayurvedic medicine as supportive care in Polyarteritis Nodosa

The Ayurvedic view

Ayurveda has no classical name that matches polyarteritis nodosa. Practitioners may describe vessel inflammation in terms of Rakta (blood) and Pitta imbalance. This is a traditional frame, not a medical diagnosis.

Therapies that may be used

Care is individualized and traditionally includes:

• Diet and daily routine, such as regular meals and steady sleep hours, adapted to any kidney, blood pressure or digestive restrictions from your physicians
• Gentle relaxation and breathing practices for stress and sleep
• Herbs, only if your physician agrees and only prescribed individually by a qualified practitioner

Panchakarma is a traditional set of cleansing procedures. It is not appropriate during pregnancy, acute illness or frailty, and it is not suitable for active vasculitis, kidney or gut involvement, or while taking immune-suppressing drugs.

What the research shows

No clinical trials of Ayurvedic treatment for polyarteritis nodosa were found, so the evidence for the disease is none.

Some evidence exists for stress. A meta-analysis of 12 trials found ashwagandha reduced anxiety and stress compared with placebo, though the certainty was low and the trials were in other groups.^[9] A meta-analysis of five trials found a small improvement in sleep, with limited long-term safety data.^[10] Neither studied vasculitis or people taking immune-suppressing drugs, so ashwagandha should only be considered with your rheumatologist's knowledge.

Herbal medicine as supportive care in Polyarteritis Nodosa

Herbs and formulas that have been studied

No herbs or herbal formulas have been studied in clinical trials for polyarteritis nodosa. We do not name any herb as a treatment for it.

What the research shows

The evidence for herbal medicine in this disease is none. Because the disease is serious and treated with powerful drugs, we do not use herbs to treat it. Any herb considered is for a symptom such as poor sleep, and only after your physician has reviewed it.

Safety and herb-drug interactions

Herbs can interact with the medicines used in this disease. A review of herb-drug interactions describes St John's wort lowering blood levels of ciclosporin, an immune-suppressing drug, with reports of organ rejection.^[11] The same review notes that herbs can affect other drugs, with serious consequences in some cases.^[11] Case reports also describe bleeding when warfarin is combined with herbs including dan shen, dang gui, ginger, ginseng and Boswellia.^[12]

Herbal and dietary supplements account for about 20% of cases of drug-related liver injury in the United States, and the liver can already be under strain from medicines or hepatitis B.^[13] About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[14] Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This section is interpretation, not equivalence. Chinese medicine may describe vessel disease with pain and skin nodules as blood stasis, heat or dampness obstructing the channels. Ayurveda may describe it as vitiated blood and Pitta. Researchers studying symptoms of this kind look at things that loosely parallel these ideas, such as nerve pain, sleep and the stress response, but no study has linked them to polyarteritis nodosa.

The biological process in polyarteritis nodosa is immune-driven inflammation and necrosis in the walls of medium-sized arteries.^[1] No study shows that a TCM pattern or a dosha corresponds to that process.

How this care fits with your medical care

Supportive care here sits alongside your rheumatologist's treatment. Polyarteritis nodosa needs specialist-directed care, and a guideline supports early treatment of severe disease with established drugs.^[3] Never stop, lower or skip steroids, cyclophosphamide, methotrexate, antiviral medicine or any other prescribed treatment on your own. We do not diagnose or manage the disease, change prescriptions, or replace your physicians.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, your medicine list including the doses and schedule of immune-suppressing drugs, hepatitis test results, and recent kidney and liver tests.

When to seek urgent medical care

Polyarteritis nodosa can cause bleeding and clots in the arteries of the gut, heart, brain and kidneys, and these need emergency care.^[2]

• Severe or worsening abdominal pain, or blood in the stool
• Chest pain, shortness of breath or fainting
• Sudden weakness, trouble speaking, confusion or a severe headache
• New or fast-worsening numbness or weakness in a hand, foot or leg
• Very high blood pressure, severe headache with vision changes, or sharply reduced urine
• Fever with signs of infection while taking steroids or immune-suppressing drugs

If you have any of these, call 911 or go to the nearest emergency department.