Vasculitic peripheral neuropathy: Case definition and guidelines for collection, analysis, and presentation of immunisation safety data

Hadden, Robert D.M.; Collins, Michael; Živković, Saša; Hsieh, Sung‐Tsang; Bonetto, Caterina; Felicetti, Patrizia; Marchione, Pasquale; Santuccio, Carmela; Bonhoeffer, Jan

doi:10.1016/j.vaccine.2015.11.047

Cited by 40 publications

(38 citation statements)

References 43 publications

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“…A duration of symptoms <12 months, high levels of rheumatoid factor, anaemia, leukocytosis, and fever were also associated with SVN, but were deemed insufficiently specific to exclude NSVN. In 2015, the Brighton Collaboration Vasculitic Peripheral Neuropathy (VPN) Working Group adapted these criteria with only one substantive change -the addition of "Brighton case definition for any form of vasculitis other than nerve or muscle" as a new but partially redundant exclusion criterion 16 . course, but the disease steadily progresses in 40% 3,19,34,35 .…”

Section: Classification Of the Vasculitidesmentioning

confidence: 99%

“…Definite vasculitis was divided according to the presence of active or chronic lesions, which coexist in most vasculitic neuropathies. The Peripheral Nerve Society guideline group's definition has been adapted without substantive changes by the Brighton Collaboration VPN Working Group 16 .…”

Section: Histopathological Diagnosismentioning

confidence: 99%

“…The key finding was that vessel-bound CD3 + T cells and CD68 + macrophages were significantly more prevalent in samples from patients with NSVN than those from controls. On the basis of this evidence, the Brighton Collaboration case definition of vasculitic neuropathy included "perivascular mononuclear inflammation in skin biopsy obtained concurrently with nerve biopsy" as a sixth criterion to support the diagnosis of histopathologically probable vasculitic neuropathy 16 .…”

Section: Histopathological Diagnosismentioning

confidence: 99%

“…The Brighton Collaboration case definition was developed in 2015 as a practical clinical tool to help nonspecialists identify patients with vasculitic neuropathy 16 . Although intended for use in epidemiological studies of adverse effects of vaccination, the definition is equally suitable for vaccination-unrelated cases.…”

Section: Brighton Collaboration Case Definition Of Vasculitic Neuropamentioning

confidence: 99%

“…Definitions adapted from Hadden et al 16 *Clinical features that are suggestive of vasculitic neuropathy are: electrodiagnostic or clinical examination evidence of peripheral neuropathy and a clinical presentation that is typical for vasculitic neuropathy (multifocal or asymmetric, involving sensory or sensory-motor nerves, lower limb-predominant, painful and with one or more acute attacks). Full details are available in the Brighton Collaboration case definition 16 .…”

Section: Level 3 Definition (Minimum Acceptable Evidence)mentioning

confidence: 99%

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The nonsystemic vasculitic neuropathies

2017

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The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

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Section: Classification Of the Vasculitidesmentioning

confidence: 99%

Section: Histopathological Diagnosismentioning

confidence: 99%

Section: Histopathological Diagnosismentioning

confidence: 99%

Section: Brighton Collaboration Case Definition Of Vasculitic Neuropamentioning

confidence: 99%

Section: Level 3 Definition (Minimum Acceptable Evidence)mentioning

confidence: 99%

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The nonsystemic vasculitic neuropathies

2017

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Vasculitic neuropathy: Comparison of clinical predictors with histopathological outcome

et al. 2019

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Introduction:To improve diagnostic accuracy, in this study we compared prebiopsy clinical parameters with subsequent pathological confirmation of peripheral nerve vasculitis. Methods: Clinical, laboratory, and neurophysiological parameters were analyzed for consecutive patients referred for nerve biopsy with suspected vasculitis. Patients were assigned pathological categories of definite, probable, possible, or absent vasculitis using validated guidelines. Patients with definite or probable vasculitis were considered to have pathologically confirmed vasculitis. Results: From a cohort of 78 patients, biopsy confirmed vasculitis in 29.5%. Parameters that best differentiated between pathologically confirmed and pathologically unlikely vasculitis were stepwise clinical progression (34.8% vs. 5.6%), the presence of serum anti‐myeloperoxidase antibody (28.6% vs. 2.2%) and rheumatoid factor seropositivity (38.1% vs. 10.7%). Pathologically absent vasculitis was frequent in patients with normal (100%) or primarily demyelinating (87.5%) nerve conduction studies. Discussion: Factoring the negative predictors of pathologically confirmed vasculitis into decision‐making can reduce the frequency of diagnostically unhelpful nerve biopsies. Muscle Nerve 59:643–649, 2019

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Nerve biopsy: Current indications and decision tools

et al. 2021

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After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

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Vasculitic peripheral neuropathy: Case definition and guidelines for collection, analysis, and presentation of immunisation safety data

Cited by 40 publications

References 43 publications

The nonsystemic vasculitic neuropathies

The nonsystemic vasculitic neuropathies

Vasculitic neuropathy: Comparison of clinical predictors with histopathological outcome

Nerve biopsy: Current indications and decision tools

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