Tamihiro Kawakami1, Yoshinao Soma. 1. Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan. tami@marianna-u.ac.jp
Abstract
BACKGROUND: Cutaneous polyarteritis nodosa (CPN) is an uncommon disorder that can be difficult to manage effectively. We have previously suggested that CPN might be associated with the presence of anti-phosphatidylserine-prothrombin complex (anti-PS/PT) antibodies, members of the antiphospholipid antibody family. OBJECTIVE: To evaluate clinical manifestations and effective treatments of CPN. METHODS: We conducted a retrospective analysis of three patients with CPN who responded to warfarin therapy. IgG and IgM anti-PS/PT antibodies were measured with a specific enzyme-linked immunosorbent assay. RESULTS: There was a dramatic improvement in our three CPN patients following warfarin therapy adjusted to a target international normalized ratio (INR) of about 3.0. Active disease progression was halted by sustained warfarin therapy during which the patients experienced resolution of their skin manifestations. LIMITATIONS: A small number of cases were studied and the study design was retrospective. CONCLUSION: We propose that warfarin therapy at a target INR of roughly 3.0 could be effective for treating patients with CPN. We further believe that treatment with warfarin led to the effective attenuation of anti-PS/PT antibodies related to prothrombin, and improved the symptoms in our CPN patients.
BACKGROUND:Cutaneous polyarteritis nodosa (CPN) is an uncommon disorder that can be difficult to manage effectively. We have previously suggested that CPN might be associated with the presence of anti-phosphatidylserine-prothrombin complex (anti-PS/PT) antibodies, members of the antiphospholipid antibody family. OBJECTIVE: To evaluate clinical manifestations and effective treatments of CPN. METHODS: We conducted a retrospective analysis of three patients with CPN who responded to warfarin therapy. IgG and IgM anti-PS/PT antibodies were measured with a specific enzyme-linked immunosorbent assay. RESULTS: There was a dramatic improvement in our three CPNpatients following warfarin therapy adjusted to a target international normalized ratio (INR) of about 3.0. Active disease progression was halted by sustained warfarin therapy during which the patients experienced resolution of their skin manifestations. LIMITATIONS: A small number of cases were studied and the study design was retrospective. CONCLUSION: We propose that warfarin therapy at a target INR of roughly 3.0 could be effective for treating patients with CPN. We further believe that treatment with warfarin led to the effective attenuation of anti-PS/PT antibodies related to prothrombin, and improved the symptoms in our CPNpatients.