Kato A, et al. - Authors evaluated the clinical or laboratory markers related to relapse of cutaneous polyarteritis nodosa (CPAN). Findings suggested a correlation of pretreatment status of cutaneous ulcer, the serum C-reactive protein level, the blood absolute neutrophil count (ANC), the neutrophil-to-lymphocyte ratio, and the systemic immune-inflammation index with a worse prognosis in CPAN.

Methods

• Experts conducted this retrospective case series at a dermatology clinic of a tertiary referral center in Okayama, Japan, from October 1, 2001, through April 30, 2017.
• Out of 30 patients identified with CPAN, the 21 with histopathologic evidence of disease were eligible and enrolled in the study.
• They evaluated the medical database for sex, age at diagnosis, affected anatomical sites, type and extent of skin lesion, laboratory data, initial therapies, duration of follow-up, and current status.
• They defined the relapse as the first reoccurrence or new onset of cutaneous disease that required further escalation of treatment with prednisolone at a dosage of greater than 20 mg/d and/or add-on use of immunosuppressant therapy, more than 6 months after initial treatment.
• They statistically evaluated the pretreatment factors between the groups without and with relapse.

Results

• Findings suggested that the 21 patients included 5 males and 16 females with a median age of 49 years (range, 11-74 years) at diagnosis.
• As per data, the median follow-up was 42 months (range, 8-374 months).
• Results demonstrated a significant association of pretreatment cutaneous ulcer with relapse between the 2 groups (0 of 11 in the nonrelapse group vs 4 of 10 in the relapse group; Χ21=4.67;P < .05).
• Researchers, in the laboratory test results, observed significantly higher mean (SD) values in the relapse group for C-reactive protein level (0.23 [2.00] vs 6.03 [3.10] mg/dL; standard error of the mean [SEM], 3.40 mg/dL; 95% CI, 0.01-10.8 mg/dL;P=.01), absolute neutrophil count (ANC) (3.4 × 103/μL [1.1 × 103/μL] vs 6.0 × 103/μL [3.2 × 103/μL]; SEM, 2.9 × 103/μL; 95% CI, 1.9 × 103/μL to 14.6 × 103/μL;P=.001), neutrophil-to-lymphocyte ratio (1.4 [0.8] vs 2.8 [0.9]; SEM, 1.2; 95% CI, 1.1-4.9;P=.002), and systemic immune-inflammation index (5.1 × 105 [3.9 × 105] vs 11.7 × 105 [7.7 × 105]; SEM, 7.3 × 105; 95% CI, 3.3 × 105 to 31.1 × 105;P=.007).
• They found a significantly high estimated 2-year cumulative relapse rate in the patients with blood ANC of greater than 4.9 × 103/μL compared with 4.9 × 103/μL or less (9 of 10 [90%] vs 2 of 11 [18%]; 95% CI, 6%-72%).