Vasculitis is a systemic illness with inflammation in the blood vessels. The inflammation may lead to occlusion of blood vessels and subsequent ischemia in the organs and tissues. When the inflammation is in the blood vessels supplying peripheral nerves, patients may develop vasculitic neuropathy.
The symptoms of vasculitic neuropathy depend on the type and location of the nerve fiber involved. It often causes both sensory and motor dysfunction, which manifest itself as unusual sensations (paresthesias), numbness, pain and weakness of the muscles in the limbs. Unlike many of the other peripheral neuropathies, vasculitic neuropathy can be very asymmetric and affect one limb more than the rest.
Diagnosis of vasculitic neuropathy is based on history, clinical examination and supporting laboratory investigations. These include electromyography with nerve conduction studies, skin biopsies to evaluate cutaneous nerve innervation, and nerve and muscle biopsies for histopathological evaluation.
Treatment of vasculitic neuropathies depends on controlling the underlying inflammation in the blood vessels. Since the underlying blood vessel inflammation is an autoimmune disorder, vasculitic neuropathy often responds to immunomodulatory therapies. The patients are initially treated with corticosteroids. However, long-term use of corticosteroids is associated with multiple complications and patients are often switched to “corticosteroid-sparing” agents. Acute exacerbations of symptoms can sometimes be treated with intravenous immune globulins (IVIG) or plasma exchange. Neuropathic pain due to vasculitic neuropathy can be treated with anti-seizure medications, antidepressants, or analgesics including opiate drugs. In severe painful conditions patients may be referred to the Blaustein Chronic Pain Clinic for a multidisciplinary approach to pain management.