Peripheral neuropathies in rheumatic disease--a guide to diagnosis

Peripheral neuropathy is a common neurological disorder that can be associated with a wide range of conditions, including rheumatic disease. Although the association of the two disorders can be coincidental, an underlying pathogenic link can occur in many instances, which can affect treatment options. The presentation of peripheral neuropathy can be multifaceted, an important consideration when recognizing the condition and optimizing diagnosis. Furthermore, understanding the diagnostic strategy will help physicians treating patients with rheumatic disease who develop peripheral neuropathy. Finally, although available treatment options have greatly reduced the risk of patients with inflammatory disorders developing systemic complications, among which includes peripheral neuropathy, new therapeutic agents can trigger toxic or immune-mediated neuropathies and treatment will need to be adjusted accordingly. In this Review, we will discuss the general approach for diagnosing patients with peripheral neuropathy, and detail the presentation, pathophysiological features and general rules of treatment of patients with peripheral neuropathy in the context of rheumatic disease.