From the Research
Peripheral neuropathy in essential mixed cryoglobulinemia occurs primarily due to immune complex-mediated damage to peripheral nerves, and treatment should focus on addressing the underlying cryoglobulinemia with immunosuppressive therapy and antiviral therapy if hepatitis C virus is the underlying cause. The pathophysiology of peripheral neuropathy in essential mixed cryoglobulinemia involves the deposition of cryoglobulins in small blood vessels, including those supplying peripheral nerves (vasa nervorum), leading to vasculitis, ischemia, and direct inflammatory damage to nerve fibers, causing axonal degeneration, particularly affecting sensory and motor nerves in a length-dependent pattern 1. Some studies have investigated the prevalence and characteristics of peripheral neuropathy in mixed cryoglobulinemia, with one study finding that 48% of patients had a neuropathy, and electrophysiologic variables were altered in 82% of patients, suggesting that peripheral neuropathy is a common complication of mixed cryoglobulinemia 2. Other studies have explored the relationship between hepatitis C virus infection and peripheral neuropathy in mixed cryoglobulinemia, with one study finding that 10 out of 15 patients with peripheral neuropathy and essential mixed cryoglobulinaemia were positive for anti-HCV antibodies, and that HCV-positive patients had a more pronounced and widespread motor deficit compared to HCV-negative patients 3. The treatment of peripheral neuropathy in essential mixed cryoglobulinemia typically involves immunosuppressive therapy, such as rituximab, cyclophosphamide, or corticosteroids, often combined with plasmapheresis to rapidly remove circulating cryoglobulins in severe cases, and antiviral therapy if hepatitis C virus is the underlying cause, as it is in most type II cryoglobulinemia cases 4, 5. Key points to consider in the treatment of peripheral neuropathy in essential mixed cryoglobulinemia include:
- The use of immunosuppressive therapy to address the underlying cryoglobulinemia
- The importance of antiviral therapy if hepatitis C virus is the underlying cause
- The potential benefits of plasmapheresis in severe cases
- The need for careful monitoring of patients with peripheral neuropathy and essential mixed cryoglobulinemia to adjust treatment as needed. Overall, the management of peripheral neuropathy in essential mixed cryoglobulinemia requires a comprehensive approach that takes into account the underlying pathophysiology and the potential benefits and risks of different treatment options.