Clinical, electrophysiological and laboratory parameters, and outcome in patients with biopsy proven systemic and nonsystemic vasculitic neuropathy

• Published in: Neurology India Vol. 67; no. 7; pp. 62 - 70
• Main Authors: Ramineni, Kiran, Chandra, Sadanandavalli, Mahadevan, Anita, Kulkarni, Girish, Ramanujam, C
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Adolescent; Adult; Aged; Biopsy; Care and treatment; Female; Histopathology; Humans; Inflammation; Laboratories; Male; Middle Aged; Nervous system; Patient outcomes; Patients; Peripheral nervous system diseases; Peripheral Nervous System Diseases - complications; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - pathology; Peripheral Nervous System Diseases - physiopathology; Peripheral neuropathy; Polyneuropathies - complications; Steroids; Studies; Systemic Vasculitis - complications; Systemic Vasculitis - diagnosis; Systemic Vasculitis - pathology; Systemic Vasculitis - physiopathology; Vasculitis; Vasculitis - complications; Vasculitis - diagnosis; Vasculitis - pathology; Vasculitis - physiopathology; Young Adult; Electrophysiological evaluation; systemic vasculitis; neuropathy; vasculitis Key Message: Peripheral neuropathy is a common feature in both systemic and non-systemic vasculitis. Recognition and early treatment of this condition is vital for achieving a good outcome; nerve biopsy; vasculitis
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.250709

Aim: To describe the clinical and laboratory findings of patients with biopsy proven vasculitic neuropathy. Introduction: Peripheral neuropathies form one of the most common disorders of the nervous system. However, more than 50% of them are labelled as 'idiopathic' and, therefore, treatment options become less. In this study, we tried to evaluate the phenotypic as well as laboratory characteristics and outcome of patients with biopsy proven vasculitic neuropathy. Patients and Methods: Review of biopsy proven definite or probable vasculitic neuropathy was done. Results: The cohort consisted of 67 subjects. There were 21 patients of systemic vasculitis (SVS) and 46 of non-systemic vasculitic neuropathy (NSVN). The nerve biopsy revealed definite vasculitis in 37 and probable vasculitis in 30 patients. The symptoms at onset were paraesthesia (68.7%), and paraesthesia and weakness (28.4%). Diffuse polyneuropathy occurred in 70.1% patients. The course was chronic in the majority (80.59%) of patients. Electrophysiology revealed mononeuritis multiplex in 32.84%, and polyneuropathy in 67.16% of patients. Pure sensory neuropathy was present in 16.42%. Among the patients who had undergone bilateral nerve conduction studies, the majority (71.05%) of patients had an asymmetric neuropathy. An elevated erythrocyte sedimentation rate (ESR) was observed in 80.59% (mean 71.57 ± 30.81 mm/1hr [in SVS] and 35.24 ± 21.62mm/1 hr in NSVN) of patients. The treatment included steroids, other immunomodulators, and symptomatic medications. The mean follow up was 10.98 ± 9.58 months. The outcome was good in 73.46% (43.8% with SVS and 87.88% with NSVN) patients, with those having a NSVN having a significantly better outcome. Conclusion: Vasculitis is a potentially treatable cause of peripheral neuropathy. The clinical features, electrophysiology, laboratory results and nerve biopsy may help in the diagnosis and categorization of patients into non-systemic and systemic vasculitic neuropathies. The long-term outcome is better in patients with NSVN compared to those with systemic vasculitis.