APRIL 1951 VOL. III NO. 4 Circulkation the Jourruafof the American Jeart Association Polyarteritis Nodosa A Correlation of Clinical and Postmortem Findings in Seventeen Cases By GEORGE C. GRIFFITH, M.D., AND I. LUTFI VURAL, M.D. The correlation of the clinical and postmortem findings shows that there is no close relationship between the syndrome of polyarteritis nodosa and the allergic states, that pain is the most common symptom, that congestive heart failure is the common cause of death. There is no consistent rela- tionship of the symptomatology referable to the gastrointestinal, central nervous, and pulmonary systems to the pathologic lesions found. Above all, it is to be noted that although hypertension is one of the most frequent signs of polyarteritis, it may develop very late. Therefore, the rejection of this diagnosis because of the absence of hypertension will lead to error, as may the absence of eosinophilia and subcutaneous nodules. T HE GROSS pathologic features of this disease were first described by von Roki- tanskyl in 1852. Fourteen years later Kussmaul and Maierla endeavored to present the microscopic as well as the gross pathology and first used the name periarteritis nodosa. Since that time a good many names have been used for this disease. W. E. Carnegie Dickson2 distinguished between the true periarteritis no- dosa and polyarteritis acuta nodosa. According to this author, true periarteritis nodosa com- mences in and affects chiefly the outer coat of the diseased vessels and the majority of the instances are due to syphilis. On the other hand, he recognized a rare group of cases which are characterized by the presence of small localized nodules situated upon the walls of the smaller and medium-sized arteries. These nodules are due to localized inflammatory, destructive and proliferative changes occurring in the vessel walls. The most important part of the change probably is complete destruction of localized areas in the muscular coat. The name poly- From the University of Southern California, School of Medicine, Department of Cardiology; and the Los Angeles County Hospital, Los Angeles, Calif. 481 arteritis acuta nodosa, suggested by Ferrari in 1903, should be applied to this latter type of disease. In addition, other authors call this dis- ease necrotizing panarteritis, and some use the name of essential polyarteritis. Because of com- mon usage, in this paper the syndrome will be referred to as polyarteritis nodosa. Many organisms have been accused as the causative agent of the disease.3-5 According to some investigators there is good reason to be- lieve that bacterial or other hypersensitivity is responsible for polyarteritis nodosa in many cases.!67 The disease is a destructive "inflammatory- necrotizing" reaction of the vascular tree. The small elastic arteries and arterioles are chiefly affected. The frequency with which various parts of the body are involved was listed by Arkin8 as follows: kidneys, 80 per cent; heart, 70 per cent; liver, 65 per cent; gastrointestinal tract, 50 per cent; pancreas, 25 per cent; mes- enteric artery, 30 per cent; muscles, 30 per cent; peripheral nerves, 20 per cent; and central nervous system, 8 per cent. Polyarteritis nodosa may occur at any age; 10 days and 77 years are the recorded ex- Circulation, Volume III, April, 1951 Downloaded from http://ahajournals.org by on June 9, 2023
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