Study on Clinical Courses of Vasculitic Neuropathies

ABSTRACT

Vasculitic neuropathy is a clinical manifestation affecting peripheral nerve in necrotizing vasculitis. It is generally regarded that natural courses are poor as there are abundant histologic and electrophysiologic evidences of axonal destruction. In this study, authors collected 15 cases of vasculitic neuropathy these six years and analyzed the data retrospectively to understand the clinical course. In 15 cases, the diagnosis of vasculitic neuropathy was made by the prominent clinical features, electrophysiological findings and sural nerve biopsies. Four cases were associated with polyarterits nodosa, one with systemic lupus erythematosus, two with rheumatoid arthritis, and one with polyangiitis overlap syndrome. However in other seven- cases the underlying dignoses were not made completely, but suspected some vasculitic conditions, such as isolated PNS vasculitis or undefined connective tissue disease. Electrophysiological studies showed mononeuritis multiplex in six, sensonmotor polvneuropathy in seven, and overlapped mononeuritis multiplex and polyneuropathy in two. Typical necrotizing vasculitis was found in nine out of twelve sural nerve biopsies. During the follow up period for up to two years, there was much improvement in ten, slight in three, and no improvement in two. In ten out of twelve patients prednisolone or prednisolone plus cyclophosphamide regimens showed improvement. Therefore authors thought that the clinical outcome was relatively fair in vasculitic neu . Ropathy when the therapy was started very early and the tirne factor between the onset and the uutiation of immunosuppressant therapy could be very important and critical.