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Factors Distinguishing Nonsystemic Versus Systemic Vasculitic Peripheral Neuropathy: A Retrospective Cohort Study
Berling Edouard1,2, Maisonobe Thierry3,4, Morassi Olivier5
1Service de Neurologie, AP-HP, Hôpital Raymond Poincaré, Centre de référence Nord-Est-Ile-de-France, FHU PHENIX, Garches, France.
Background:
Prompt differentiation of nonsystemic vasculitic neuropathy (NSVN) from systemic vasculitic neuropathy (SVN) without antineutrophil cytoplasmic antibodies or organ involvement (SVN-) is challenging but crucial given the differences in management. Our primary objective was to identify predictors of SVN- versus NSVN.
Methods:
We retrospectively identified patients seen at either of two centers for histologically definite or probable vasculitic neuropathy diagnosed as SVN- or NSVN. Clinical, electromyographic, laboratory, and histological data at diagnosis and last follow-up were collected.
Results:
We included 98 patients, of whom 46 (47%) had NSVN and 52 (53%) SVN-. Symptoms and neurophysiological findings did not significantly differ between the two groups. By univariate analysis, compared to the NSVN group, the SVN- group had more patients with C-reactive protein ≥ 10 mg/L (44.2% vs. 17.4%, p < 0.01), antinuclear antibodies (42.3% vs. 21.7%, p = 0.04), and low C3 or C4 (23.1% vs. 4.3%, p = 0.02). All three associations were confirmed by multivariate analysis. By multivariate analysis adjusted for symptom duration, muscle vasculitis also was associated with SVN- (OR, 8.33; 95% CI, 2.63-25.00; p < 0.01).
Conclusion:
Simple, readily available laboratory and histological variables may help to rapidly distinguish SVN from NSVN.
