Which rheumatological diseases manifest with peripheral neuropathy?

From the Guidelines

Systemic Lupus Erythematosus (SLE), Inflammatory Bowel Disease (IBD), and Multiple Myeloma are rheumatological diseases that can manifest with peripheral neuropathy.

Key Points

• SLE patients are at increased risk of several neuropsychiatric manifestations, including peripheral nervous disorders, which can be diagnosed using nerve conduction studies and treated with glucocorticoids and immunosuppressive therapy 1.
• IBD patients can develop peripheral neuropathy, which is often related to disease activity and can be treated with immunotherapy, such as IV Ig 1.
• Multiple Myeloma patients can develop peripheral neuropathy due to the plasma cell dyscrasia itself or as a result of treatment with certain drugs, such as thalidomide and bortezomib, which can cause iatrogenic neurotoxicity 1.

Diagnosis and Treatment

• Diagnosis of peripheral neuropathy in these diseases often involves nerve conduction studies, electromyography, and MRI.
• Treatment options include glucocorticoids, immunosuppressive therapy, and immunotherapy, such as IV Ig.
• In Multiple Myeloma, dose adjustment algorithms can help reduce the side effects of certain drugs while maintaining anti-tumor efficacy.

Important Considerations

• Peripheral neuropathy can be a significant predictor of damage in SLE patients.
• IBD-related peripheral neuropathy can be considered after excluding well-known risk factors, such as vitamin and mineral deficiencies.
• Early detection of peripheral neuropathy is crucial in Multiple Myeloma patients to reduce the side effects of treatment and maintain quality of life.

From the Research

Rheumatological Diseases with Peripheral Neuropathy

The following rheumatological diseases have been found to manifest with peripheral neuropathy:

• Systemic lupus erythematosus 2, 3
• Rheumatoid arthritis 2, 3, 4
• Sjögren's syndrome 2, 5
• Systemic vasculitis 2, 5
• Gout 3
• Osteoarthritis 3

Types of Peripheral Neuropathy

The types of peripheral neuropathy associated with these rheumatological diseases include:

• Mononeuropathy 3, 5
• Multiplex mononeuropathy 3, 5
• Polyneuropathy 3, 5

Diagnostic Approaches

Diagnostic approaches for peripheral neuropathy in rheumatological diseases include:

• Clinical history 6, 2
• Nerve conduction studies 6, 2, 3
• High-Resolution Ultrasound (HRUS) 6
• Electromyogram data 4
• Nerve and/or other tissue biopsy 5

Risk Factors

Risk factors for peripheral neuropathy in rheumatoid arthritis patients include:

• Low total protein (< 63 g/L) 4
• Low anti-CCP levels (< 285.7 U/ml) 4
• High inflammatory parameters (white blood cells, platelet, C-reactive protein (CRP), erythrocyte sedimentation rate, rheumatoid factor) 4