Updates in peripheral nerve vasculitis

It is important for clinicians to perform a systemic examination of patients presenting with apparent cases of isolated peripheral nerve vasculitis, the Neurology Update Meeting 2024 heard.

Dr Junie Koay, Consultant Neurologist, National Hospital of Neurology and Neurosurgery, London, UK, delivered a lecture entitled ‘Peripheral nerve vasculitis: Update and future directions’.

Dr Koay said a wider examination is needed to ascertain whether there is systemic involvement.

“That will potentially open up different treatments that are available,” she told the Medical Independent (MI).

The diagnosis of vasculitic neuropathy relies on a patient’s medical history, clinical examination, and supporting laboratory tests.

Dr Koay said basic tests include performing a urinalysis to ascertain whether there is renal involvement, and a chest x-ray to assess the lungs.

“More in-depth investigations can then be conducted if you find a suggestive picture on bloods or the history, for example,” she told MI.

She added that collaboration with other specialties is also key, both in terms of diagnosis and treatment.

The standard treatment for the condition is cyclophosphamide and glucocorticoids.

However, Dr Koay highlighted that newer treatments have come on-stream, such as complement inhibitors and anti-eosinophilic medications.

“They are available if you fulfil particular criteria,” she said.

Dr Koay said peripheral nerve vasculitis responds well to treatment, particularly when diagnosed early.

“Because it’s an inflammatory disease, it is very treatable. The time to diagnosis is important because the longer you go without a diagnosis the more there is this ongoing inflammatory and nerve death from ischaemia. So, if you can stop that process and control it, then you allow recovery.”