Polyarteritis nodosa

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Polyarteritis nodosa is a systemic vasculitis.

It can present with psychiatric features such as depression, anxiety, behavioural change, cognitive dysfunction, mood disturbance, and, less commonly, psychosis.

Other characteristic features include peripheral neuropathy (particularly mononeuritis multiplex), headache, seizures, stroke, encephalopathy, and constitutional symptoms including fever and weight loss. Distinctive features include a necrotizing medium-vessel vasculitis with multisystem involvement, classically sparing the pulmonary circulation (helping differentiate it from the ANCA-associated vasculitides).

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Cardiovascular: hypertension due to renal artery involvement, together with an increased risk of arterial aneurysms and ischemic complications.

  • Renal/electrolytes: renal ischemia and renovascular hypertension are common; unlike ANCA-associated vasculitis, glomerulonephritis is typically absent.

  • Hepatobiliary: association with chronic hepatitis B infection in a subset of patients.

  • Gastrointestinal: abdominal pain (particularly postprandial), mesenteric ischemia, gastrointestinal bleeding, and bowel infarction or perforation may occur.

  • Musculoskeletal: myalgia, arthralgia, and muscle tenderness are common.

  • Dermatologic: livedo reticularis, subcutaneous nodules, purpura, digital ischemia, and cutaneous ulceration may occur.

Early diagnosis is important to enable prompt immunosuppressive treatment, identify and treat associated hepatitis B infection when present, prevent irreversible ischemic injury to the kidneys, gastrointestinal tract, peripheral nerves, and other organs, reduce the risk of life-threatening vascular complications, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.