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  • Review Article
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Peripheral neuropathies in rheumatic disease—a guide to diagnosis

Nature Reviews Rheumatology volume 8, pages 599–609 (2012)Cite this article

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Abstract

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.

Key Points

  • Peripheral neuropathy is frequently seen in patients with rheumatic disease, but extensive epidemiological data are lacking

  • The first steps in the diagnostic strategy of peripheral neuropathy include a detailed history, a careful clinical evaluation and complete electrodiagnostic tests

  • The causal link between peripheral neuropathy and rheumatic disease mainly includes compression by joint deformation or swelling, vasculitis or drug toxicity

  • The relationship between the two disorders is incompletely understood in many situations, as is the case, for example, for most of the peripheral neuropathies associated with rheumatoid arthritis, systemic lupus erythematosus and Sjögren's syndrome

  • The care of patients with this combination of disorders necessitates a multidisciplinary approach

  • Nerve and/or muscle biopsy might be necessary to understand the mechanism of peripheral nerve involvement in many patients with rheumatic disease; skin biopsy can be helpful to confirm the diagnosis of small-fibre neuropathy

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Figure 1: Example histological sections of axonal lesions.
Figure 2: Example histological sections of demyelinating neuropathies.
Figure 3: Histological findings from superficial peroneal nerve biopsy.
Figure 4: Clinical and radiographic aspects of neuropathic arthropathy.

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  1. Centre National de Référence Neuropathies Périphériques Rares, Service et Laboratoire de Neurologie, 2 Avenue Martin Luther King, CHU Limoges, Limoges, 87042, France

    Jean-Michel Vallat, Magalie Rabin & Laurent Magy

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All authors made equal contributions to researching data for and writing this Review. J.-M. Vallat and L. Magy made equal contributions to discussion of content and reviewing and/or editing the manuscript before submission.

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Correspondence to Jean-Michel Vallat.

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Vallat, JM., Rabin, M. & Magy, L. Peripheral neuropathies in rheumatic disease—a guide to diagnosis. Nat Rev Rheumatol 8, 599–609 (2012). https://doi.org/10.1038/nrrheum.2012.138

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