Este protocolo aborda pacientes con poliarteritis nodosa activa y grave que presentan manifestaciones que amenazan la vida o los órganos y son incapaces de tolerar la ciclofosfamida.
Las manifestaciones graves en este contexto incluyen enfermedad renal, mononeuritis múltiple, enfermedad muscular, isquemia mesentérica, afectación coronaria e isquemia de extremidades o dedos.
La guía basada en evidencia recomienda condicionalmente iniciar el tratamiento con glucocorticoides en pulsos IV, combinados con un agente inmunosupresor no glucocorticoide, en lugar de glucocorticoides solos — la alternativa preferida cuando la ciclofosfamida no es una opción.
DOI: 10.1002/art.41776
Severe disease: Vasculitis with life- or organ-threatening manifestations (e.g., renal disease, mononeuritis multiplex, muscle disease, mesenteric ischemia, coronary involvement, limb/digit ischemia)
For patients with newly diagnosed active, severe PAN who are unable to tolerate cyclophosphamide, we conditionally recommend treating with other nonglucocorticoid immunosuppressive agents and glucocorticoids over glucocorticoids alone.
For patients with newly diagnosed active, severe PAN, we conditionally recommend initiating treatment with intravenous (IV) pulse glucocorticoids over high-dose oral glucocorticoids.
In patients unable to tolerate cyclophosphamide, another agent, such as azathioprine or methotrexate, is recommended over glucocorticoid monotherapy.
Absence of clinical signs or symptoms attributed to PAN, on or off immunosuppressive therapy
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