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Background: Cutaneous polyarteritis nodosa (CPAN) is a small-to-medium vessel vasculitis limited to the skin. As it is a rare condition, there is little data available to guide treatment. Previous articles have suggested that colchicine and dapsone be used in mild disease and glucocorticoids in acute flares, with DMARDs such as methotrexate or azathioprine being reserved for moderate to severe disease, or steroid-refractory disease. Objectives: Our objective was to review therapeutic regimens used to treat CPAN and to evaluate patient response. Methods: A retrospective chart review including records from January 2003 to June 2017 was performed to identify patients with both histologic and clinical features of CPAN. We extracted information regarding patient age, clinical presentation, biopsy results, and response to treatment. Results: Thirteen patients were identified who had clinical features of CPAN that were supported by histologic findings on biopsy. The majority of patients were female (92.3%). The average age at diagnosis was 44.9 years and mean duration of follow up was 53 months. All patients had involvement of the lower limbs with the most common cutaneous manifestation being subcutaneous nodules (92.3%), followed by papules (46.2%) and livedo reticularis (30.8%). Eight out of thirteen patients (61.5%) received steroids and three did not experience clinical benefit. Another patient did not respond to prednisone and hydroxychloroquine, but had significant improvement of her symptoms on prednisone and methotrexate. Seven out of nine patients (77.8%) who were treated with methotrexate had a favourable response. Three of those patients responded to methotrexate after failing other therapies such as dapsone, azathioprine, and prednisone. Conclusion: In this case series, we found that most patients had a favorable response to methotrexate and thus the role of methotrexate in treating CPAN merits further investigation. As CPAN often has a chronic relapsing and remitting course, initiating methotrexate at the same time as steroid therapy may lower overall lifetime exposure to steroids. References [1] Daoud MS, Hutton KP, Gibson LE. Cutaneous periarteritis nodosa: a clinicopathological study of 79 cases. Br J Dermatol. 1997May;136(5):706–13. [2] Ross K, Contreras J, aung-Din D, Lien M. Asymptomatic cutaneous polyarteritis nodosa: treatment options and therapeutic guidelines. Cutis. 2017Aug;100(2):125–8. [3] Maillard H, Szczesniak S, Martin L, Garot D, Machet MC, Machet L, et al. [Cutaneous periarteritis nodosa: diagnostic and therapeutic aspects of 9 cases]. Ann Dermatol Venereol. 1999Feb;126(2):125–9. [4] Khoo BP, Ng SK. Cutaneous polyarteritis nodosa: a case report and literature review. Ann acad Med Singapore. 1998Nov;27(6):868–72. [5] Schartz NEC, alaoui S, Vignon-Pennamen MD, Cordoliani F, Fermand JP, Morel P, et al. Successful treatment in two cases of steroid-dependent cutaneous polyarteritis nodosa with low-dose methotrexate. Dermatology. 2001;203(4):336–8. Disclosure of interests: Mohan Stewart: None declared, ada Lo: None declared, Kamran Shojania: None declared, Sheila au: None declared, Jan Dutz: None declared, Michael Seidman: None declared, Jon Chan Grant/research support from: Janssen, UCB, Novartis, Pfizer, Celgene, Consultant for: amgen, Celgene, Eli Lilly, Janssen, amgen, abbvie, Novartis, Pfizer, UCB, Sandoz, Merck

Background Polyarteritis nodosa is a small vessel to medium vessel vasculitis that frequently presents with multi-organ involvement, but can sometimes be limited to single organs such as the testes. Patients often require treatment with glucocorticoids, plus or minus additional immunosuppressive therapy depending on the severity of the disease. We describe a rare case of polyarteritis nodosa involving the right testis and urinary bladder without other systemic features of vasculitis. Case presentation A previously healthy 54-year-old First Nations Canadian man presented with intermittent gross hematuria. He underwent surgical excision of his right testis for cryptorchidism and a transurethral resection of a bladder mass. Histology showed an active medium vessel vasculitis in both organs. On extensive clinical, laboratory, and radiographic review, he had no systemic features of vasculitis. On 2-year follow-up, he has not required any systemic therapy and has not developed further symptoms. Conclusion Single organ polyarteritis nodosa can sometimes be managed with surgical excision of the involved organ alone. Although our patient had two organs involved, we extrapolated the results of our literature search to guide his care. This case highlights the potential for surgical excision to cure polyarteritis nodosa despite the involvement of two organs in the absence of symptoms and signs of systemic vasculitis.

Pain management is a cornerstone of osteoarthritis (OA) management. The aim of this review is to obtain current, literature-based estimates of the effect of common pharmacologic treatments on pain reduction in OA. A MEDLINE search (2006–2016) was conducted for randomized controlled trials studying acetaminophen, oral NSAIDs, topical NSAIDs, COX-2 inhibitors, and opioids in the treatment of OA pain. Drug effect on pain was estimated using relative change in pain, and expressed as percentage change. An overall effect for each drug category was obtained as a weighted average of study-specific effects, with weights based on each study’s sample size. Twenty-nine studies were included. The effect on pain was estimated in a total of 43 treatment arms (acetaminophen n = 6, oral NSAIDs n = 9, topical NSAIDs n = 8, COX-2 inhibitors n = 9, and opioids n = 11). Relative (%) changes in pain were found to be as follows: acetaminophen = 32.5, oral NSAIDs = 34.3, topical NSAIDs = 40.9, COX-2 inhibitors = 36.9, and opioids = 35.4. The effects of 5 major drug categories in the treatment of OA pain were reviewed with data extracted from 29 studies published from 2006 to 2016. Acetaminophen was found to have an RC value close to that of oral NSAIDs. The effects of oral NSAIDs, COX-2 inhibitors, and opioids in controlling pain were similar to what has been demonstrated in previous literature. Topical NSAIDs were found to have a greater RC than oral NSAIDs.