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Vasculitic Neuropathy Treatment & Management

  • Author: Abbas Mehdi, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
Updated: Feb 05, 2015

Medical Care

Early use of an aggressive immunosuppressive agent is indicated to treat vasculitic neuropathy.

Combination therapy with corticosteroids and cyclophosphamide is reported to be more effective than monotherapy in inducing remission and improving disability and in reducing relapse rate and chronic pain.

One cohort study shows a 61% response rate with a 59% relapse rate with corticosteroid monotherapy compared with a 95% response rate with a 29% relapse rate in combination therapy of corticosteroids and cyclophosphamide.

Treat systemic necrotizing vasculitis and nonsystemic vasculitis with a combination of prednisone and cyclophosphamide or, less commonly, azathioprine (Imuran), methotrexate, and intravenous immunoglobulin.

  • Administer prednisone for 2-3 months or until clinical beneficial effect is noted; then taper gradually according to the patient's response. The typical starting dose is 40-100 mg/d, which is eventually tapered to every other day dosing to avoid side effects. Cyclophosphamide is started at 100-150 mg/d.
  • Continue treatment for 6 months to 1 year or longer. Some patients may require long-term immunosuppression for years.
  • Discuss adverse affects and toxicity of long-term use of corticosteroids and immunosuppressive agents with the patient and family prior to onset of therapy.

Symptomatic treatment of neuropathic pain can be initiated with amitriptyline and/or nortriptyline, carbamazepine, or gabapentin. Other systemic manifestations of systemic vasculitis require management according to organ involvement and specialty consultation.



Systemic vasculitis can involve multiple organ systems. A multispecialty team effort is recommended.

  • Neurologist: Neurologist consultation is indicated for diagnosis and treatment of the disease. Neurologist consultation is necessary for electrodiagnostic studies and muscle and nerve biopsy.
  • Rheumatologist: Rheumatologist consultation is necessary, especially in systemic vasculitis.
  • Physical medicine and rehabilitation specialist: Begin physical therapy and occupational therapy as soon as the patient's condition is stable enough for therapy.


No special diet is required; however, diet precautions should be provided when corticosteroids are initiated. Patients with diabetes need careful glucose control. Patients should be on potassium supplements if long-term steroid treatment is necessary.



Most patients in the acute stage of vasculitic neuropathy can be ill if overt signs of other generalized systemic vasculitis are present. Otherwise, activity may be restricted secondary to weakness in the distribution of involved nerves. Encourage ambulation and physical therapy when the patient's condition is stable.

Contributor Information and Disclosures

Abbas Mehdi, MD Director, MDA Center of Central California; Consulting Staff, Department of Neurology, California Neurological Center, Inc

Abbas Mehdi, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Medical Association

Disclosure: Nothing to disclose.


Said R Beydoun, MD Chief, Professor, Department of Neurology, University Hospital, University of Southern California

Said R Beydoun, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Additional Contributors

Norman C Reynolds, Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds, Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, International Parkinson and Movement Disorder Society, Sigma Xi, Society for Neuroscience

Disclosure: Nothing to disclose.

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Diagnostic classification of peripheral vasculitic neuropathy (PVN).
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