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血管炎性神经病的诊断、评估及管理的当前观点

Current perspectives on the diagnosis, assessment, and management of vasculitic neuropathy.

作者信息

Fukami Yuki, Koike Haruki, Katsuno Masahisa

机构信息

Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Expert Rev Neurother. 2022 Nov-Dec;22(11-12):941-952. doi: 10.1080/14737175.2022.2166831. Epub 2023 Jan 17.

Abstract

INTRODUCTION

Vasculitic neuropathy can present associated with both primary and secondary systemic vasculitis as a result from underlying diseases such as rheumatic diseases and infections, Moreover, confined vasculitis in the peripheral nervous system may be present. Thus, the diagnosis and management of vasculitic neuropathy require multidisciplinary approaches.

AREAS COVERED

Current views as well as relevant clinical research on the diagnosis, assessment, and management of vasculitic neuropathy are reviewed to suggest appropriate treatment strategies. We searched PubMed and Google Scholar for reports published between July 2017 and July 2022.

EXPERT OPINION

For the treatment of vasculitic neuropathy, determining the causative primary disease is important and often requires diagnosis by tissue biopsy. Due to the scarce research on the treatment of vasculitic neuropathy, treatment is empirically based on findings from studies of systemic vasculitides involving other organs, particularly antineutrophil cytoplasmic antibody-associated vasculitis. In addition to conventional glucocorticoids and immunosuppressive agents, complement-targeted therapy, anti-B-cell therapy, and disease-specific molecular targeted therapies have recently gained relevance. Future research is needed to develop new patient-specific therapeutic options.

摘要

引言

血管炎性神经病可与原发性和继发性系统性血管炎相关,其病因包括风湿性疾病和感染等潜在疾病。此外,周围神经系统也可能出现局限性血管炎。因此,血管炎性神经病的诊断和管理需要多学科方法。

涵盖领域

本文回顾了血管炎性神经病诊断、评估和管理的当前观点以及相关临床研究,以提出适当的治疗策略。我们在PubMed和谷歌学术上搜索了2017年7月至2022年7月发表的报告。

专家意见

对于血管炎性神经病的治疗,确定病因性原发性疾病很重要,通常需要通过组织活检进行诊断。由于关于血管炎性神经病治疗的研究较少,治疗是基于对涉及其他器官的系统性血管炎研究结果的经验性治疗,特别是抗中性粒细胞胞浆抗体相关血管炎。除了传统的糖皮质激素和免疫抑制剂外,补体靶向治疗、抗B细胞治疗和疾病特异性分子靶向治疗最近也受到关注。未来需要开展研究以开发新的针对患者的治疗选择。

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