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New Drug Improves Outlook for Polyarteritis Nodosa | |
By DR. HILLEL TOBIAS A new antiviral drug has improved the outlook for many patients with polyarteritis nodosa, a disease which once had a death rate of 85 percent or higher. The treatment is based on the discovery that at least half of all cases of polyarteritis nodosa are caused by an abnormal immune response to infection with the viruses that cause hepatitis B or C. About 1 million Americans carry the virus for hepatitis B, and as many as 3.5 million are infected with the hepatitis C virus. In polyarteritis nodosa, there is acute inflammation of medium-sized blood vessels in many parts of the body - joints, nerves, the skin, the kidneys, the intestinal tract. Symptoms of the disease can include malaise, fever, joint pain, skin ulcers, abdominal pain and neurologic changes that cause local or general pain, numbness or weakness. The condition can also cause high blood pressure and kidney disease. Without treatment, death is caused by failure of the heart, kidneys or other vital organs. Because of the large variety of symptoms, polyarteritis nodosa is not easy to recognize in a given patient. To make the diagnosis, the physician who suspects the disease must make a biopsy of an affected area and examine the tissue sample under a microscope to detect the telltale blood vessel abnormalities. When positive, those diagnostic measures are followed by blood tests to look for the presence of the viruses for hepatitis B or hepatitis C. Until recently, treatment for all cases of polyarteritis nodosa started with high doses of corticosteroids, which increased the survival rate appreciably. For those patients whose disease is caused by hepatitis B or C, treatment now also includes injections of interferon alpha, an antiviral drug that has been available for a number of years. The newer antiviral drug that is being used is lamivudine, marketed as Epivir which is effective in treating hepatitis B. While interferon must be given by injection, the new drug can be taken orally, which makes its use much easier. Not all patients with polyarteritis nodosa can be helped by these drugs. They are effective only when the hepatitis viruses cause the condition. There still is a percentage of cases in which the underlying cause of the blood vessel inflammation is unknown. Research to discover the other causes of the disease and to develop effective treatments is ongoing. --- Dr. Hillel Tobias is Associate Professor in Clinical Medicine at New York University School of Medicine. Copyright 1996 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. | |