Use of warfarin therapy at a target international normalized ratio of 3.0 for cutaneous polyarteritis nodosa

BackgroundCutaneous 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.ObjectiveTo evaluate clinical manifestations and effective treatments of CPN.MethodsWe 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.ResultsThere 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.LimitationsA small number of cases were studied and the study design was retrospective.ConclusionWe 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.