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PAN FFS-Guided Treatment — SCE Rheumatology MCQ

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ModerateVasculitisPAN FFS-Guided TreatmentSCE Rheumatology

A 50-year-old woman with polyarteritis nodosa (ANCA-negative hepatitis B-negative) has constitutional symptoms mononeuritis multiplex and skin vasculitis. The Five Factor Score is 0 (no poor prognostic factors). What is the recommended treatment?

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Correct answer: D — Plasma exchange as routine induction for non-severe disease

In idiopathic PAN (ANCA-negative HBV-negative) the treatment approach is guided by the Five Factor Score. For FFS 0 (no cardiac renal severe GI CNS involvement or age >65) glucocorticoid monotherapy may be sufficient. For FFS ≥1 (indicating poor prognostic features) addition of Cyclophosphamide is recommended. This FFS-stratified approach balances efficacy against immunosuppressive toxicity. PAN typically responds well to treatment with high remission rates. Relapse is less common than in ANCA vasculitis. Long-term outcomes depend on the severity of initial organ involvement.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions