Peripheral neuropathies during systemic diseases: Part I (connective tissue diseases and granulomatosis)

• Published in: La revue de medecine interne Vol. 44; no. 4; p. 164
• Main Authors: Pacoureau, L, Urbain, F, Venditti, L, Beaudonnet, G, Cauquil, C, Adam, C, Goujard, C, Lambotte, O, Adams, D, Labeyrie, C, Noel, N
• Format: Journal Article
• Language: English; French
• Published: France 01.04.2023
• Subjects: Antibodies, Antinuclear; Autoantibodies; Connective Tissue Diseases - complications; Humans; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - etiology; Maladie de système; Systemic disease; Connective disease; Granulomatosis; Peripheral neuropathy; Connectivite; Neuropathie périphérique; Granulomatose
• ISSN: 1768-3122; 1768-3122
• DOI: 10.1016/j.revmed.2023.01.004

Systemic diseases (connective disease, granulomatosis) may be associated with peripheral neuropathies. The diagnosis can be complex when the neuropathy is the presenting manifestation of the disease, requiring close collaboration between neurologists and internists. Conversely, when the systemic disease is already known, the main question remaining is its imputability in the neuropathy. Regardless of the situation, the positive diagnosis of neuropathy is based on a systematic and rigorous electro-clinical investigation, specifying the topography, the evolution and the mechanism of the nerve damage. Certain imaging examinations, such as nerve and/or plexus MRI, or other more invasive examinations (skin biopsy, neuromuscular biopsy) enable to specify the topography and the mechanism of the injury. The imputability of the neuropathy in the course of a known systemic disease is based mainly on its electro-clinical pattern, on which the alternatives diagnoses depend. In the case of an inaugural neuropathy, a set of arguments orients the diagnosis, including the underlying terrain (young subject), possible associated systemic manifestations (inflammatory arthralgias, polyadenopathy), results of first-line laboratory tests (lymphopenia, hyper-gammaglobulinemia, hypocomplementemia), autoantibodies (antinuclear, anti-native DNA, anti-SSA/B) and sometimes invasive examinations (neuromuscular biopsy).