Klinik, Diagnostik und Therapie der vaskulitischen Neuropathie

Zusammenfassung

Unter vaskulitischen Neuropathien versteht man immunvermittelte Erkrankungen des peripheren Nervensystems, bei denen die Schädigung der Nerven durch eine Entzündung der Blutgefäße bedingt ist. Unterschieden werden vaskulitische Neuropathien bei primären und sekundären systemischen Vaskulitiden, bei entzündlich-rheumatischer Systemerkrankung, bei malignen Erkrankungen, medikamenteninduzierte Vaskulitiden und die nicht systemische vaskulitische Neuropathie (NSVN). Das typische klinische Erscheinungsbild einer vaskulitischen Neuropathie ist eine asymmetrische oder multifokale, schmerzhafte, sensomotorische Neuropathie mit akutem/subakutem oder chronischem Verlauf mit schubförmigen Verschlechterungen. Charakteristisch sind weiterhin der elektrophysiologische Nachweis einer aktiven, asymmetrischen, axonalen sensomotorischen Neuropathie und die Besserung durch immunsuppressive Therapie. Eine gesicherte Vaskulitis liegt vor, wenn ein positiver Biopsiebefund erhoben wird, das Fehlen eindeutiger morphologischer Befunde schließt sie jedoch nicht aus. Es gibt keinen Labortest, der eine Vaskulitis definitiv nachweist oder ausschließt, so ist auch bei ausschließlich unauffälligen Ergebnissen von durchaus umfangreichen Blutuntersuchungen das Vorliegen einer NSVN möglich. Systemische Vaskulitiden treten mit einer Inzidenz von mindestens 4/100 000 jährlich auf und haben unbehandelt eine schlechte Prognose, die durch immunsuppressive Therapie entscheidend verbessert wird. Bei der NSVN ist die Prognose deutlich besser, eine längerfristige immunsuppressive Therapie ist auch hier häufig erforderlich. Die aktuellen Therapiestandards werden in diesem Konsensuspapier dargestellt.

Abstract

Vasculitic neuropathies are immune mediated diseases of the peripheral nervous system, in which inflammation of the blood vessels causes damage to the nerves. We distinguish neuropathies associated with primary and secondary systemic vasculitis, with rheumatic diseases, with malignant disorders, drug-induced vasculitis and the non-systemic vasculitic neuropathies (NSVN). The typical clinical picture consists in an asymmetric or multifocal, painful sensorimotor neuropathy with an acute, subacute or chronic course and acute relapses. Neurophysiology reveals an active, asymmetric, axonal sensorimotor neuropathy. The disorders usually respond to immunosuppressive treatment. A diagnosis of definite vasculitis can be made with evidence of vasculitis in a biopsy specimen. The absence of positive morphological evidence, however, does not exclude the diagnosis. There is no single laboratory test that can prove or exclude vasculitis, in NSVN even an elaborate panel of blood tests can show normal findings. Systemic vasculitis has an incidence of 4/100 000 per year and, untreated, has a poor prognosis, which is greatly improved by the use of immunosuppressive treatment. The prognosis of NSVN is generally better, although many patients need long term immunosuppression. Current treatment recommendations for vasculitic neuropathies are presented.

Literatur

• 1 Harati Y, Niakan E. The clinical spectrum of inflammatory - angiopathic neuropathy.  J Neurol Neurosurg Psychiat. 1986;  49 1313-1316
• 2 Said G, Lacroix-Ciaudo C, Fujimura H, Blas C, Faux N. The peripheral neuropathy of necrotizing arteritis: a clinicopathological study.  Ann Neurol. 1988;  23 461-465
• 3 Kissel J T, Slivka A P, Warmolts J R, Mendell J R. The clinical spectrum of necrotizing angiopathy of the peripheral nervous system.  Ann Neurol. 1985;  18 251-257
• 4 Kissel J. Vasculitic neuropathies. In: Gilman S (eds). MedLink Neurology. San Diego: MedLink Corporation 2001
• 5 Collins M P, Mendell J R, Periquet M I, Sahenk Z, Amato A A, Gronseth G S. et al . Superficial peroneal nerve/peroneus brevis muscle biopsy in vasculitic neuropathy.  Neurology. 2000;  55 636-643
• 6 Chalk C H, Dyck P J, Conn D L. Vasculitic neuropathy. In: Dyck P, Thomas P, Griffin J, Low P, Poduslo J (eds.). Peripheral Neuropathy. Philadelphia: W.B. Saunders Company 1993: 1424-1436
• 7 Griffith M E, Gaskin G, Pusey C D. Classification, pathogenesis, and treatment of systemic vasculitis.  Ren Fail. 1996;  18 785-802
• 8 Fauci A S, Haynes B, Katz P. The spectrum of vasculitis: clinical, pathologic, immunologic and therapeutic considerations.  Ann Intern Med. 1978;  89 660-676
• 9 McCluskey R T, Fienberg R. Vasculitis in primary vasculitides, granulomatoses, and connective tissue diseases.  Hum Pathol. 1983;  14 305-315
• 10 Lie J T. Systemic and isolated vasculitis. A rational approach to classification and pathologic diagnosis.  Pathol Annu. 1989;  24 25-114
• 11 Churg J, Churg A. Idiopathic and secondary vasculitis: a review.  Mod Pathol. 1989;  2 144-160
• 12 Waldherr R, Eberlein-Gonska M, Noronha I L. Histopathological differentiation of systemic necrotizing vasculitides.  APMIS Suppl. 1990;  19 17-18
• 13 Hunder G G, Arend W P, Bloch D A, Calabrese L H, Fauci A S, Fries J F. et al . The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction.  Arthritis Rheum. 1990;  33 1065-1067
• 14 Jennette J C, Falk R J, Andrassy K, Bacon P A, Churg J, Gross W L. et al . Nomenclature of systemic vasculitides. Proposal of an international consensus conference.  Arthritis Rheum. 1994;  37 187-192
• 15 Rheumatology TACo . Criteria for the classification of vasculitis.  Arthritis and rheumatism. 1990;  33 1065-1144
• 16 Hunder G G, Bloch D A, Michel B A, Stevens M B, Arend W P, Calabrese L H. et al . The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.  Arthritis Rheum. 1990;  33 1122-1128
• 17 Bruce I N, Bell A L. A comparison of two nomenclature systems for primary systemic vasculitis.  Br J Rheumatol. 1997;  36 453-458
• 18 Dyck P J, Benstead T J, Conn D L, Stevens L C, Windebank A J, Low P A. Nonsystemic vasculitic neuropathy.  Brain. 1987;  110 843-854
• 19 Bouche P, Léger J M, Travers M A, Cathala H P, Castaigne P. Peripheral neuropathy in systemic vasculitis: clinical and electrophysiologic study of 22 patients.  Neurology. 1986;  36 1598-1602
• 20 Gran J T, Myklebust G, Wilsgaard T, Jacobsen B K. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls.  Rheumatology (Oxford). 2001;  40 1238-1242
• 21 Olney R K. AAEM minimonograph #38: Neuropathies in connective tissue disease.  Muscle Nerve. 1992;  15 531-542
• 22 Caselli R J, Hunder G G, Whisnant J P. Neurologic disease in biopsy-proven giant cell (temporal) arteritis.  Neurology. 1988;  38 352-359
• 23 Kissel J T, Mendell J R. Vasculitic neuropathy.  Neurol Clin. 1992;  10 761-781
• 24 Irani D N. Neurologic complications of the hepatitis viruses. 3 ed.  Ann Arbor Publishing. 2000; 
• 25 Moore P M, Richardson B. Neurology of the vasculitides and connective tissue diseases.  J Neurol Neurosurg Psychiatry. 1998;  65 10-22
• 26 Godeau B, Guillevin L. Périartérite noueuse systémique. In: Kahn MK, Peltier AP (eds.). Maladies dites systémiques. Paris: Flammarion 1982: 414-445
• 27 Moore P M, Cupps T R. Neurological complications of vasculitis.  Ann Neurol. 1983;  14 155-167
• 28 Siva A. Vasculitis of the nervous system.  J Neurol. 2001;  248 451-468
• 29 Said G. Necrotizing peripheral nerve vasculitis.  Neurol Clin. 1997;  15 835-848
• 30 Salama A D. Pathogenesis and treatment of ANCA-associated systemic vasculitis.  J R Soc Med. 1999;  92 456-461
• 31 Nishino H, Rubino F A, DeRemee R A, Swanson J W, Parisi J E. Neurological involvement in Wegener's granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic.  Ann Neurol. 1993;  33 4-9
• 32 de Groot K, Schmidt D K, Arlt A C, Gross W L, Reinhold-Keller E. Standardized neurologic evaluations of 128 patients with Wegener granulomatosis.  Arch Neurol. 2001;  58 1215-1221
• 33 Lie J T. The classification of vasculitis and a reappraisal of allergic granulomatosis and angiitis (Churg-Strauss syndrome).  Mt Sinai J Med. 1986;  53 429-439
• 34 Gross W L. Systemic necrotizing vasculitis. In: Yazaki H, Husby G (eds.). Clinical Rheumatology: Baillière's 1997: 259-284
• 35 Chumbley L C, Harrison Jr E G, DeRemee R A. Allergic granulomatosis and angiitis (Churg-Strauss syndrome). Report and analysis of 30 cases.  Mayo Clin Proc. 1977;  52 477-484
• 36 Guillevin L, Durand-Gasselin B, Cevallos R, Gayraud M, Lhote F, Callard P. et al . Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients.  Arthritis Rheum. 1999;  42 421-430
• 37 Nadeau S E, Watson R T. Neurologic manifestations of systemic vasculitis and collagen vascular syndromes. In: Baker AB, Joynt RA (eds.). Clinical Neurology. Philadelphia: Harper & Row 1983: 29-34
• 38 Gemignani F, Pavesi G, Fiocchi A, Manganelli P, Ferraccioli G, Marbini A. Peripheral neuropathy in essential mixed cryoglobulinaemia.  J Neurol Neurosurg Psychiatry. 1992;  55 116-120
• 39 Cavaletti G, Petruccioli M G, Crespi V, Pioltelli P, Marmiroli P, Tredici G. A clinico-pathological and follow up study of 10 cases of essential type II cryoglobulinaemic neuropathy.  J Neurol Neurosurg Psychiatry. 1990;  53 886-889
• 40 Engelhardt A. Vaskulitische Neuropathien. Regensburg: Roderer Verlag 1994
• 41 Hawke S H, Davies L, Pamphlett R, Guo Y P, Pollard J D, McLeod J G. Vasculitic neuropathy. A clinical and pathological study.  Brain. 1991;  114 2175-2190
• 42 Olney R K. Neuropathies associated with connective tissue disease.  Semin Neurol. 1998;  18 63-72
• 43 Panegyres P K, Blumbergs P C, Leong A S, Bourne A J. Vasculitis of peripheral nerve and skeletal muscle: clinicopathological correlation and immunopathic mechanisms.  J Neurol Sci. 1990;  100 193-202
• 44 Drenkard C, Villa A R, Reyes E, Abello M, Alarcon-Segovia D. Vasculitis in systemic lupus erythematosus.  Lupus. 1997;  6 235-242
• 45 Omdal R, Mellgren S I, Husby G, Salvesen R, Henriksen O A, Torbergsen T. A controlled study of peripheral neuropathy in systemic lupus erythematosus.  Acta Neurol Scand. 1993;  88 41-46
• 46 Mellgren S I, Conn D L, Stevens J C, Dyck P J. Peripheral neuropathy in primary Sjogren's syndrome.  Neurology. 1989;  39 390-394
• 47 Molina R, Provost T T, Alexander E L. Peripheral inflammatory vascular disease in Sjogren's syndrome. Association with nervous system complications.  Arthritis Rheum. 1985;  28 1341-1347
• 48 Mauch E, Volk C, Kratzsch G, Krapf H, Kornhuber H H, Laufen H. et al . Neurological and neuropsychiatric dysfunction in primary Sjogren's syndrome.  Acta Neurol Scand. 1994;  89 31-35
• 49 Gemignani F, Marbini A, Pavesi G, di Vittorio S, Manganelli P, Cenacchi G. et al . Peripheral neuropathy associated with primary Sjogren's syndrome.  J Neurol Neurosurg Psychiatry. 1994;  57 983-986
• 50 Lafitte C, Amoura Z, Cacoub P, Pradat-Diehl P, Picq C, Salachas F. et al . Neurological complications of primary Sjogren's syndrome.  J Neurol. 2001;  248 577-584
• 51 Hietaharju A, Jaaskelainen S, Kalimo H, Hietarinta M. Peripheral neuromuscular manifestations in systemic sclerosis (scleroderma).  Muscle Nerve. 1993;  16 1204-1212
• 52 Averbuch-Heller L, Steiner I, Abramsky O. Neurologic manifestations of progressive systemic sclerosis.  Arch Neurol. 1992;  49 1292-1295
• 53 Lori S, Matucci-Cerinic M, Casale R, Generini S, Lombardi A, Pignone A. et al . Peripheral nervous system involvement in systemic sclerosis: the median nerve as target structure.  Clin Exp Rheumatol. 1996;  14 (6) 601-605
• 54 Kimber T E, Scott G, Thompson P D, Beare J H. Vasculitic neuropathy and myopathy occurring as a complication of mixed connective tissue disease.  Aust N Z J Med. 1999;  29 82-83
• 55 Watts R A, Carruthers D M, Scott D G. Epidemiology of systemic vasculitis: changing incidence or definition?.  Semin Arthritis Rheum. 1995;  25 28-34
• 56 Puechal X, Said G, Hilliquin P, Coste J, Job-Deslandre C, Lacroix C. et al . Peripheral neuropathy with necrotizing vasculitis in rheumatoid arthritis. A clinicopathologic and prognostic study of thirty-two patients.  Arthritis Rheum. 1995;  38 1618-1629
• 57 Scott D G, Bacon P A, Tribe C R. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases.  Medicine (Baltimore). 1981;  60 288-297
• 58 Wattiaux M J, Kahn M F, Thevenet J P, Sauvezie B, Imbert J C. L'atteinte vasculaire dans la polyarthrite rhumatoide. Etude retrospective de 37 polyarthrites rhumatoides avec atteinte vasculaire et revue de la litterature.  Ann Med Interne. 1987;  138 566-587
• 59 Cruickshank B. The arteritis of rheumatoid arthritis.  Ann Rheum Dis. 1954;  13 136
• 60 Good A E, P C R, Knepke G H, Bender L F, E T M. Peripheral neuropathy associated with rheumatoid arthritis.  Ann Intern Med. 1965;  63 87-99
• 61 Endtz L J, Frenay J, Goor C. Vasculitic neuropathy in RA.  Neurology. 1983;  33 1635-1636
• 62 Rosenbaum R. Neuromuscular complications of connective tissue diseases.  Muscle Nerve. 2001;  24 154-169
• 63 Calabrese L H, Estes M, Yen-Lieberman B, Proffitt M R, Tubbs R, Fishleder A J. et al . Systemic vasculitis in association with human immunodeficiency virus infection.  Arthritis Rheum. 1989;  32 569-576
• 64 Brannagan 3rd T H. Retroviral-associated vasculitis of the nervous system.  Neurol Clin. 1997;  15 927-944
• 65 Bradley W G, Verma A. Painful vasculitic neuropathy in HIV-1 infection: relief of pain with prednisone therapy.  Neurology. 1996;  47 1446-1451
• 66 Drueke T, Barbanel C, Jungers P, Digeon M, Poisson M, Brivet F. et al . Hepatitis B antigen-associated periarteritis nodosa in patients undergoing long-term hemodialysis.  Am J Med. 1980;  68 86-90
• 67 Heckmann J G, Kayser C, Heuss D, Manger B, Blum H E, Neundörfer B. Neurological manifestations of chronic hepatitis C.  J Neurol. 1999;  246 486-491
• 68 Sergent J S, Lockshin M D, Christian C L, Gocke D J. Vasculitis with hepatitis B antigenemia: long-term observation in nine patients.  Medicine (Baltimore). 1976;  55 1-18
• 69 Shusterman N, London W T. Hepatitis B and immune-complex disease.  N Engl J Med. 1984;  310 43-46
• 70 Dawson T M, Starkebaum G. Isolated central nervous system vasculitis associated with hepatitis C infection.  J Rheumatol. 1999;  26 2273-2276
• 71 Halperin J J, Little B W, Coyle P K, Dattwyler R J. Lyme disease. Cause of a treatable peripheral neuropathy.  Neurology. 1987;  37 1700-1706
• 72 Said G, Goulon-Goeau C, Lacroix C, Moulonguet A. Nerve biopsy findings in different patterns of proximal diabetic neuropathy.  Ann Neurol. 1994;  35 559-569
• 73 Schäfers M, Neukirchen S, Toyka K V, C S. Borrelia neuropathy: histologic and immunohistochemical characterization.  J Peripher Nerv Syst. 2001;  6 175
• 74 Meier C, Grehl H. Vaskulitische Neuropathie bei Garin-Bujadoux-Bannwarth-Syndrom. Ein Beitrag zum Verstandnis der Pathologie und Pathogenes neurologischer Komplikationen bei Lyme-Borreliose.  Dtsch Med Wochenschr. 1988;  113 135-138
• 75 Meier C, Grahmann F, Engelhardt A, Dumas M. Peripheral nerve disorders in Lyme-Borreliosis. Nerve biopsy studies from eight cases.  Acta Neuropathol. 1989;  79 271-278
• 76 Sommer C, Schröder J M. Immune mediated neuropathy and myopathy in post streptococcal disease: electron microscopical, morphometrical, and immunohistochemical studies.  Clin Neuropathol. 1992;  11 77-86
• 77 Eggers C, Hagel C, Pfeiffer G. Anti-Hu-associated paraneoplastic sensory neuropathy with peripheral nerve demyelination and microvasculitis.  J Neurol Sci. 1998;  155 178-181
• 78 Blumenthal D, Schochet Jr S, Gutmann L, Ellis B, Jaynes M, Dalmau J. Small-cell carcinoma of the lung presenting with paraneoplastic peripheral nerve microvasculitis and optic neuropathy.  Muscle Nerve. 1998;  21 1358-1359
• 79 Oh S J. Paraneoplastic vasculitis of the peripheral nervous system.  Neurol Clin. 1997;  15 849-863
• 80 Vincent D, Dubas F, Hauw J J, Godeau P, Lhermitte F, Buge A. et al . Nerve and muscle microvasculitis in peripheral neuropathy: a remote effect of cancer?.  J Neurol Neurosurg Psychiatry. 1986;  49 1007-1010
• 81 Hamidou M A, El Kouri D, Audrain M, Grolleau J Y. Systemic antineutrophil cytoplasmic antibody vasculitis associated with lymphoid neoplasia.  Ann Rheum Dis. 2001;  60 293-295
• 82 Navarro J F, Quereda C, Rivera M, Navarro F J, Ortuno J. Anti-neutrophil cytoplasmic antibody-associated paraneoplastic vasculitis.  Postgrad Med J. 1994;  70 373-375
• 83 Ponge T, Boutoille D, Moreau A, Germaud P, Dabouis G, Baranger T. et al . Systemic vasculitis in a patient with small-cell neuroendocrine bronchial cancer.  Eur Respir J. 1998;  12 1228-1229
• 84 Schapira D, Balbir-Gurman A, Nahir A M. Naproxen-induced leukocytoclastic vasculitis.  Clin Rheumatol. 2000;  19 242-244
• 85 Choi H K, Merkel P A, Walker A M, Niles J L. Drug-associated antineutrophil cytoplasmic antibody-positive vasculitis: prevalence among patients with high titers of antimyeloperoxidase antibodies.  Arthritis Rheum. 2000;  43 405-413
• 86 Noh J Y, Asari T, Hamada N, Makino F, Ishikawa N, Abe Y. et al . Frequency of appearance of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) in Graves' disease patients treated with propylthiouracil and the relationship between MPO-ANCA and clinical manifestations.  Clin Endocrinol (Oxf). 2001;  54 651-654
• 87 Sanchez J, Coll Canti J, Ariza A, Olive A, Cuixart A, Teixido J. Neuropatia por vasculitis necrotizante: estudio anatomoclinico, neurofisiologico y evolucion terapeutica de 26 pacientes.  Rev Neurol. 2001;  33 1033-1036
• 88 Tassin S, Ferriere G, Laterre E C. Mononevrite multiple dans un cas de macroglobulinemie de Waldenstrom.  Acta Neurol Belg. 1980;  80 287-297
• 89 Said G, Lacroix C, Plante-Bordeneuve V, Le Page L, Pico F, Presles O. et al . Nerve granulomas and vasculitis in sarcoid peripheral neuropathy: a clinicopathological study of 11 patients.  Brain. 2002;  125 264-275
• 90 Fernandes S R, Singsen B H, Hoffman G S. Sarcoidosis and systemic vasculitis.  Semin Arthritis Rheum. 2000;  30 33-46
• 91 Vital C, Aubertin J, Ragnault J M, Amigues H, Mouton L, Bellance R. Sarcoidosis of the peripheral nerve: a histological and ultrastructural study of two cases.  Acta Neuropathol. 1982;  58 111-114
• 92 Said G, Elgrably F, Lacroix C. Painful proximal diabetic neuropathy: inflammatory nerve lesions and spontaneous favorable outcome.  Ann Neurol. 1997;  41 762-770
• 93 Diaz-Perez J L, Winkelmann R K. Cutaneous periarteritis nodosa.  Arch Dermatol. 1974;  110 407-414
• 94 Goldberg J W, Lee M L, Sajjad S M. Giant cell arteritis of the skin simulating erythema nodosum.  Ann Rheum Dis. 1987;  46 706-708
• 95 Wees S J, Sunwoo I N, Oh S J. Sural nerve biopsy in systemic necrotizing vasculitis.  Am J Med. 1981;  71 525-532
• 96 Schröder J M. Pathologie peripherer Nerven. Berlin: Springer-Verlag 1999
• 97 Davies L, Spies J M, Pollard J D, McLeod J G. Vasculitis confined to peripheral nerves.  Brain. 1996;  119 1441-1448
• 98 Dyck P J, Conn D L, Okazaki H. Necrotizing angiopathic neuropathy. Three-dimensional morphology of fiber degeneration related to sites of occluded vessels.  Mayo Clin Proc. 1972;  47 461-475
• 99 Hartung H P, Gold R, Jung S. Local immune responses in the PNS. In: Antel J, Birnbaum G, Hartung HP (eds.). Clinical Neuroimmunology Oxford: Blackwell Science 1998: 40-54
• 100 Moore P M. Immune mechanisms in the primary and secondary vasculitides.  J Neurol Sci. 1989;  93 129
• 101 Kissel J T, Riethman J L, Omerza J, Rammohan K W, Mendell J R. Peripheral nerve vasculitis: immune characterization of the vascular lesions.  Ann Neurol. 1989;  25 291-297
• 102 Engelhardt A, Lörler H, Neundorfer B. Immunohistochemical findings in vasculitic neuropathies.  Acta Neurol Scand. 1993;  87 318-321
• 103 Panegyres P K, Faull R J, Russ G R, Appleton S L, Wangel A G, Blumbergs P C. Endothelial cell activation in vasculitis of peripheral nerve and skeletal muscle.  J Neurol Neurosurg Psychiatry. 1992;  55 4-7
• 104 Satoi H, Oka N, Kawasaki T, Miyamoto K, Akiguchi I, Kimura J. Mechanisms of tissue injury in vasculitic neuropathies.  Neurology. 1998;  50 492-496
• 105 Sundy J S, Haynes B F. Cytokines and adhesion molecules in the pathogenesis of vasculitis.  Curr Rheumatol Rep. 2000;  2 402-410
• 106 Chalk C H, Homburger H A, Dyck P J. Anti-neutrophil cytoplasmic antibodies in vasculitis peripheral neuropathy.  Neurology. 1993;  43 1826-1827
• 107 Jennette J C, Falk R J. Clinical and pathological classification of ANCA-associated vasculitis: what are the controversies?.  Clin Exp Immunol. 1995;  101 Suppl 1 18-22
• 108 Heuss D, Probst-Cousin S, Kayser C, Neundorfer B. Cell death in vasculitic neuropathy.  Muscle Nerve. 2000;  23 999-1004
• 109 Gold R, Hartung H P, Lassmann H. T-cell apoptosis in autoimmune diseases: termination of inflammation in the nervous system and other sites with specialized immune-defense mechanisms.  Trends Neurosci. 1997;  20 399-404
• 110 Zettl U K, Gold R, Toyka K V, Hartung H P. In situ demonstration of T cell activation and elimination in the peripheral nervous system during experimental autoimmune neuritis in the Lewis rat.  Acta Neuropathol (Berl). 1996;  91 360-367
• 111 Heuss D, Bierhaus A, Schleicher E D, Nawroth P P, Neundörfer B, Haslbeck M. Oxidative stress and NFkappaB activation. Possible pathomechanisms in vasculitic neuropathy.  Neuromuscular Disorders. 2001;  11 659
• 112 Rivera-Walsh I, Cvijic M E, Xiao G, Sun S C. The NF-kappa B signaling pathway is not required for Fas ligand gene induction but mediates protection from activation-induced cell death.  J Biol Chem. 2000;  275 25222-25230
• 113 Baichwal V R, Baeuerle P A. Activate NF-kappa B or die?.  Curr Biol. 1997;  7 R94-96
• 114 Schmidt A M, Hori O, Chen J X, Li J F, Crandall J, Zhang J. et al . Advanced glycation endproducts interacting with their endothelial receptor induce expression of vascular cell adhesion molecule-1 (VCAM-1) in cultured human endothelial cells and in mice. A potential mechanism for the accelerated vasculopathy of diabetes.  J Clin Invest. 1995;  96 1395-1403
• 115 Leuschner T, Neundörfer B, Heuss D. FADD-like IL-1 β-converting enzyme-inhibitory protein (FLIP) - an antiapoptotic pathway in vasculitic neuropathy.  J Neurol Sci. 2002;  199 11
• 116 Moore P M. Vasculitic neuropathies.  J Neurol Neurosurg Psychiatry. 2000;  68 (3) 271-274
• 117 Hunder G G. Vasculitis: clinical and laboratory features. In: Schumacher HR, Klippel JH, Koopman WJ (eds.). Primer on the Rheumatic Diseases. 10 ed. Atlanta: Arthritis Foundation 1993: 14-47
• 118 Frohnert P P, Sheps S G. Long-term follow-up study of periarteritis nodosa.  Am J Med. 1967;  43 (1) 8-14
• 119 Guillevin L, Le Thi Huong D, Godeau P, Jais P, Wechsler B. Clinical findings and prognosis of polyarteritis nodosa and Churg- Strauss angiitis: a study in 165 patients.  Br J Rheumatol. 1988;  27 258-264
• 120 Charles L A, Caldas M L, Falk R J, Terrell R S, Jennette J C. Antibodies against granule proteins activate neutrophils in vitro.  J Leukoc Biol. 1991;  50 539-546
• 121 Ewert B H, Jennette J C, Falk R J. The pathogenic role of antineutrophil cytoplasmic autoantibodies.  Am J Kidney Dis. 1991;  18 188-195
• 122 Venning M C, Quinn A, Broomhead V, Bird A G. Antibodies directed against neutrophils (C-ANCA and P-ANCA) are of distinct diagnostic value in systemic vasculitis.  Q J Med. 1990;  77 1287-1296
• 123 D'Cruz D, Payne H, Timothy A, Hughes G R. Response of cyclophosphamide-resistant Wegener's granulomatosis to etoposide.  Lancet. 1992;  340 (8816) 425-426
• 124 Dolman K M, Gans R O, Vervaat T J, Zevenbergen G, Maingay D, Nikkels R E. et al . Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy.  Lancet. 1993;  342 (8872) 651-652
• 125 Vogt B A, Kim Y, Jennette J C, Falk R J, Burke B A, Sinaiko A. Antineutrophil cytoplasmic autoantibody-positive crescentic glomerulonephritis as a complication of treatment with propylthiouracil in children.  J Pediatr. 1994;  124 986-988
• 126 Lamprecht P, Moosig F, Gause A, Herlyn K, Csernok E, Hansen H. et al . Immunological and clinical follow up of hepatitis C virus associated cryoglobulinaemic vasculitis.  Ann Rheum Dis. 2001;  60 385-390
• 127 Dahlberg P J, Lockhart J M, Overholt E L. Diagnostic studies for systemic necrotizing vasculitis. Sensitivity, specificity, and predictive value in patients with multisystem disease.  Arch Intern Med. 1989;  149 161-165
• 128 Hellmann D B, Laing T J, Petri M, Whiting-O'Keefe Q, Parry G J. Mononeuritis multiplex: the yield of evaluations for occult rheumatic diseases.  Medicine (Baltimore). 1988;  67 145-153
• 129 Gilden D H, Kleinschmidt-DeMasters B K, LaGuardia J J, Mahalingam R, Cohrs R J. Neurologic complications of the reactivation of varicella-zoster virus.  N Engl J Med. 2000;  342 635-645
• 130 Garcia-Bragado F, Fernandez J M, Navarro C, Villar M, Bonaventura I. Peripheral neuropathy in essential mixed cryoglobulinemia.  Arch Neurol. 1988;  45 1210-1214
• 131 Ferri C, Marzo E, Longombardo G, Lombardini F, La Civita L, Vanacore R. et al . Interferon-alpha in mixed cryoglobulinemia patients: a randomized, crossover-controlled trial.  Blood. 1993;  81 1132-1136
• 132 Antoine J C. Immunological mechanisms in paraneoplastic peripheral neuropathy.  Clin Rev Allergy Immunol. 2000;  19 61-72
• 133 Honnorat J, Antoine J C, Derrington E, Aguera M, Belin M F. Antibodies to a subpopulation of glial cells and a 66 kDa developmental protein in patients with paraneoplastic neurological syndromes.  J Neurol Neurosurg Psychiatry. 1996;  61 270-278
• 134 Hormigo A, Dalmau J, Rosenblum M K, River M E, Posner J B. Immunological and pathological study of anti-Ri-associated encephalopathy.  Ann Neurol. 1994;  36 896-902
• 135 Peterson K, Rosenblum M K, Kotanides H, Posner J B. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients.  Neurology. 1992;  42 1931-1937
• 136 Ropert A, Metral S. Conduction block in neuropathies with necrotizing vasculitis.  Muscle Nerve. 1990;  13 102-105
• 137 Jamieson P W, Giuliani M J, Martinez A J. Necrotizing angiopathy presenting with multifocal conduction blocks.  Neurology. 1991;  41 442-444
• 138 McCluskey L, Feinberg D, Cantor C, Bird S. “Pseudo-conduction block” in vasculitic neuropathy.  Muscle Nerve. 1999;  22 1361-1366
• 139 Cornblath D R, Sumner A J. Conduction block in neuropathies with necrotizing vasculitis.  Muscle Nerve (letter). 1991;  14 185
• 140 Hömberg V, Reiners K, Toyka K V. Reversible conduction block in human ischemic neuropathy after ergotamine abuse.  Muscle Nerve. 1992;  15 467-470
• 141 Parry G J, Linn D J. Conduction block without demyelination following acute nerve infarction.  J Neurol Sci. 1988;  84 265-273
• 142 Low P A. Laboratory evaluation of autonomic function. Philadelphia: Lippincott-Raven Publishers 1997
• 143 Flachenecker P, Toyka K V, Reiners K. Herzrhythmusstörungen beim Guillain-Barre-Syndrom. Eine Übersicht zur Diagnostik einer seltenen, aber potenziell lebensbedrohlichen Komplikation.  Nervenarzt. 2001;  72 610-617
• 144 Kumazawa K, Sobue G, Aizawa I, Nakao N, Mitsuma T. [Autonomic dysfunction in vasculitic neuropathy - special reference to sudomotor function].  Rinsho Shinkeigaku. 1990;  30 599-604
• 145 McCombe P A, McLeod J G, Pollard J D, Guo Y P, Ingall T J. Peripheral sensorimotor and autonomic neuropathy associated with systemic lupus erythematosus. Clinical, pathological and immunological features.  Brain. 1987;  110 533-549
• 146 Leuschner T, Neundörfer B, Heuss D. Reliability of morphological methods in vasculitic neuropathy.  Journal of the Peripheral Nervous System. 2001;  6 156
• 147 Said G. Value of nerve biopsy?.  Lancet. 2001;  357 1220-1221
• 148 Schröder J M. Recommendations for the examination of peripheral nerve biopsies.  Virchows Arch. 1998;  432 199-205
• 149 Davidson J R, Sundstrom W R. Sural nerve biopsy in systemic necrotizing vasculitis.  Arthritis and rheumatism. 1988;  31 149-150
• 150 Gabriel C M, Howard R, Kinsella N. Prospective study of the usefulness of sural nerve biopsy.  J Neurol Neurosurg Psychiatry. 2000;  69 442-446
• 151 Van Lis J M, Jennekens F GI. Immunofluorescence studies in a case of rheumatoid neuropathy.  J Neurol Sci. 1977;  33 313-321
• 152 Kawana S. The membrane attack complex of complement alters the membrane integrity of cultured endothelial cells: a possible pathophysiology for immune complex vasculitis.  Acta Derm Venereol (Stockh). 1996;  76 13-16
• 153 Boom B W, Out-Luiting C OL, Baldwin W IM, Westedt M L, Daha M R, Vermeer B J. Membrane attack complex of complement in leukocytoclastic vasculitis of the skin.  Arch Dermatol. 1987;  123 1192-1195
• 154 Dauchel H, Joly P, Delpech A, Thomine E, Sauger F, Le Leot X. et al . Local and systemic activation of the whole complement cascade in human leukocytoclastic vasculitis; C3d,g and terminal complement complex as sensitive markers.  Clin Exp Immunol. 1993;  92 274-283
• 155 Leppert D, Hughes P, Huber S, Erne B, Grygar C, Said G. et al . Matrix metalloproteinase upregulation in chronic inflammatory demyelinating polyneuropathy and nonsystemic vasculitic neuropathy.  Neurology. 1999;  53 62-70
• 156 Asbury A K. Ischemic disorders of peripheral nerve. Amsterdam, New York, Oxford, North-Holland 1970
• 157 Dyck P JB, Norell B S, Dyck P J. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy.  Neurology. 1999;  53 2113-2121
• 158 Kelkar P, Masood M, Parry G J. Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy).  Neurology. 2000;  55 83-88
• 159 Vincent D, Dubas F, Hauw J J, R E, Godeau P, Buge A. et al . Micorvasculites nerveuses et musculaires: 50 cas.  Rev Neurol (Paris). 1985;  141 440-446
• 160 King R. Atlas of peripheral nerve pathology. London: Arnold 1999
• 161 Heuss D, Hecht M. Ätiologische Abklärung einer Polyneuropathie.  Klin Neurophysiol. 2001;  32 1-9
• 162 Parry G J, Clarke S. Multifocal acquired demyelinating neuropathy masquerading as motor neuron disease.  Muscle Nerve. 1988;  11 103-107
• 163 Lisak R P, Mendell J R. Peripheral neuropathies associated with connective tissue disorders. In: Mendell JR (ed.). Diagnosis and Management of Peripheral Nerve Disorders. Oxford: University Press 2001: 233-255
• 164 Scott D G, Watts R A. Classification and epidemiology of systemic vasculitis.  Br J Rheumatol. 1994;  33 897-899
• 165 Leib E S, Restivo C, Paulus H E. Immunosuppressive and corticosteroid therapy of polyarteritis nodosa.  Am J Med. 1979;  67 941-947
• 166 Guillevin L, Guittard T, Bletry O, Godeau P, Rosenthal P. Systemic necrotizing angiitis with asthma: causes and precipitating factors in 43 cases.  Lung. 1987;  165 165-172
• 167 Gold R, Toyka K V. Immuntherapie neurologischer Erkrankungen. Bremen: Uni-Med Verlag AG 2001
• 168 Fauci A S, Haynes B F, Katz P, Wolff S M. Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years.  Ann Intern Med. 1983;  98 76-85
• 169 Hoffman G S, Kerr G S, Leavitt R Y, Hallahan C W, Lebovics R S, Travis W D. et al . Wegener granulomatosis: an analysis of 158 patients.  Ann Intern Med. 1992;  116 488-498
• 170 Adu D, Pall A, Luqmani R A, Richards N T, Howie A J, Emery P. et al . Controlled trial of pulse versus continuous prednisolone and cyclophosphamide in the treatment of systemic vasculitis.  Qjm. 1997;  90 401-409
• 171 Gayraud M, Guillevin L, Cohen P, Lhote F, Cacoub P, Deblois P. et al . Treatment of good-prognosis polyarteritis nodosa and Churg-Strauss syndrome: comparison of steroids and oral or pulse cyclophosphamide in 25 patients. French Cooperative Study Group for Vasculitides.  Br J Rheumatol. 1997;  36 (12) 1290-1297
• 172 Guillevin L, Lhote F, Jarrousse B, Fain O. Treatment of polyarteritis nodosa and Churg-Strauss syndrome. A meta-analysis of 3 prospective controlled trials including 182 patients over 12 years.  Ann Med Interne. 1992;  143 405-416
• 173 Guillevin L, Cordier J F, Lhote F, Cohen P, Jarrousse B, Royer I. et al . A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener's granulomatosis.  Arthritis Rheum. 1997;  40 2187-2198
• 174 Luqmani R A, Jayne D. European Vasculitis Study Group. A multi-centre randomised controlled trial of cyclophosphamide versus azathioprine during remission in ANCA-associated systemic vasculitis (CYCAZAREM).  Arthritis and rheumatism. 1999;  42 S225
• 175 Rasmussen N JD, Abramowicz D, Andrassy K, Bacon P A, Cohen Tervaert J W, Dadoniené J. European therapeutic trials in ANCA-associated systemic vasculitis: disease scoring, consensus regimens and proposed clinical trials.  Clin Exp Immunol. 1995;  101 (Suppl) 101
• 176 Stone J H, Tun W, Hellman D B. Treatment of non-life threatening Wegener's granulomatosis with methotrexate and daily prednisone as the initial therapy of choice.  J Rheumatol. 1999;  26 1134-1139
• 177 Langford C A. Management of systemic vasculitis.  Best Pract Res Clin Rheumatol. 2001;  15 281-297
• 178 Sneller M C, Hoffman G S, Talar-Williams C, Kerr G S, Hallahan C W, Fauci A S. An analysis of forty-two Wegener's granulomatosis patients treated with methotrexate and prednisone.  Arthritis Rheum. 1995;  38 608-613
• 179 de Groot K, Reinhold-Keller E, Tatsis E, Paulsen J, Heller M, Nolle B. et al . Therapy for the maintenance of remission in sixty-five patients with generalized Wegener's granulomatosis. Methotrexate versus trimethoprim/sulfamethoxazole.  Arthritis Rheum. 1996;  39 2052-2061
• 180 Langford C A, Talar-Williams C, Barron K S, Sneller M C. A staged approach to the treatment of Wegener's granulomatosis: induction of remission with glucocorticoids and daily cyclophosphamide switching to methotrexate for remission maintenance.  Arthritis Rheum. 1999;  42 2666-2673
• 181 Jayne D, Gaski G. European Vasculitis Study Group (EUVAS) . Randomised trial of cyclophosphamide versus azathioprine during remission in ANCA-associated vasculitis (CACAZAREM).  J Am Soc Nephrol. 1999;  10 105A
• 182 Gaskin G, Pusey C D. Evolution of a policy to prevent vasculitis relapse.  Clin Exp Immunol. 1995;  101 (Suppl) 46
• 183 MacFadyen R, Tron V, Keshmiri M, Road J D. Allergic angiitis of Churg and Strauss syndrome. Response to pulse methylprednisolone.  Chest. 1987;  91 629-631
• 184 Scott D G, Bacon P A. Intravenous cyclophosphamide plus methylprednisolone in treatment of systemic rheumatoid vasculitis.  Am J Med. 1984;  76 377-384
• 185 Pusey C D, Rees A J, Evans D J, Peters D K, Lockwood C M. Plasma exchange in focal necrotizing glomerulonephritis without anti-GBM antibodies.  Kidney Int. 1991;  40 757-763
• 186 Palmer A, Cairns T, Dische F, Gluck G, Gjorstrup P, Parsons V. et al . Treatment of rapidly progressive glomerulonephritis by extracorporal immunoadsorption, prednisolone and cyclophosphamide.  Nephrol Dial Transplant. 1991;  6 536-542
• 187 Szprit W M, Rasmussen N JD, Pedersen J. Plasma exchange and cyclosporin A in Wegener's granulomatosis: a controlled study.  Int J Artif Organs. 1996;  10 501
• 188 Tuso P, Moudgil A, Hay J, Goodman D, Kamil E, Koyyana R. et al . Treatment of antineutrophil cytoplasmic autoantibody-positive systemic vasculitis and glomerulonephritis with pooled intravenous gammaglobulin.  Am J Kidney Dis. 1992;  20 504-508
• 189 Richter C, Schnabel A, Csernok E, De Groot K, Reinhold-Keller E, Gross W L. Treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis with high-dose intravenous immunoglobulin.  Clin Exp Immunol. 1995;  101 2-7
• 190 Hamilos D L, Christensen J. Treatment of Churg-Strauss syndrome with high-dose intravenous immunoglobulin.  J Allergy Clin Immunol. 1991;  88 823-824
• 191 Jayne D R, Esnault V L, Lockwood C M. ANCA anti-idiotype antibodies and the treatment of systemic vasculitis with intravenous immunoglobulin.  J Autoimmun. 1993;  6 207-219
• 192 Jayne D R, Davies M J, Fox C J, Black C M, Lockwood C M. Treatment of systemic vasculitis with pooled intravenous immunoglobulin.  Lancet. 1991;  337 (8750) 1137-1139
• 193 Jayne D. Evidence-based treatment of systemic vasculitis.  Rheumatology (Oxford). 2000;  39 (6) 585-595
• 194 Misiani R, Bellavita P, Fenili D, Vicari O, Marchesi D, Sironi P L. et al . Interferon α-2a therapy in cryoglobulinemia associated with hepatitis C virus.  N Engl J Med. 1994;  330 751-756
• 195 Mazzaro C, Lacchin T, Moretti M, Tulissi P, Manazzone O, Colle R. et al . Effects of two different alpha-interferon regimens on clinical and virological findings in mixed cryoglobulinemia.  Clin Exp Rheumatol. 1995;  13 Suppl 13 S181-185
• 196 Donada C, Crucitti A, Donadon V, Chemello L, Alberti A. Interferon and ribavirin combination therapy in patients with chronic hepatitis C and mixed cryoglobulinemia.  Blood. 1998;  92 2983-2984
• 197 Barbaro G, Di Lorenzo G, Soldini M, Giancaspro G, Pellicelli A, Grisorio B. et al . Intravenous recombinant interferon-beta versus interferon-α-2b and ribavirin in combination for short-term treatment of chronic hepatitis C patients not responding to interferon-α. Multicenter Interferon Beta Italian Group Investigators.  Scand J Gastroenterol. 1999;  34 928-933
• 198 Lamprecht P, Schnabel A, Gross W L. Hepatitis C virus-associated cryoglobulinemic vasculitis.  Dtsch Med Wochenschr. 1998;  123 637-642
• 199 Misiani R, Bellavita P. Mixed cryoglobulinemia. A guide to drug treatment.  Clin Immunother. 1996;  5 115-121
• 200 Lockwood C M, Thiru S, Isaacs J D, Hale G, Waldmann H. Long-term remission of intractable systemic vasculitis with monoclonal antibody therapy.  Lancet. 1993;  341 (8861) 1620-1622
• 201 Lockwood C M. Intravenous immunoglobulin for the treatment of vasculitides. In: Kazatchkine MD, Morell A (eds.). Intravenous Immunoglobulin Research and Therapy. New York: The Parthenon Publishing Group 1996: 43-45
• 202 Lockwood C M. Refractory Wegener's granulomatosis: a model for shorter immunotherapy of autoimmune diseases.  J R Coll Physicians Lond. 1998;  32 473-478
• 203 Thomas-Golbanov C, Sridharan S. Novel therapies in vasculitis.  Expert Opin Investig Drugs. 2001;  10 1279-1289
• 204 Gause A, Manger B, Kalden J R, Burmester G R. Therapie entzündlich-rheumatischer Erkrankungen: Vom Standard in die Zukunft.  Internist (Berl). 2001;  42 223 - 232-234 - 236
• 205 Metzler C, Low-Friedrich I, Reinhold-Keller E, Schmitt W H, Gross W L. Leflunomide, a new promising agent in maintenance and remission in Wegener's granulomatosis.  Clin Exp Immunol. 1998;  112 56
• 206 Nowack R, Birck R, van der Woude F J. Mycophenolate mofetil for systemic vasculitis and IgA nephropathy.  Lancet. 1997;  349 (9054) 774
• 207 Waiser J, Budde K, Braasch E, Neumayer H H. Treatment of acute c-ANCA-positive vasculitis with mycophenolate mofetil.  Am J Kidney Dis. 1999;  34 39
• 208 Richter C, Wanke L, Steinmetz J, Reinhold-Keller E, Gross W L. Mononeuritis secondary to rheumatoid arthritis responds to etanercept.  Rheumatology (Oxford). 2000;  39 (12) 1436-1437
• 209 Luqmani R A. Is it possible to offer evidence-based treatment for systemic vasculitis?.  Scand J Rheumatol. 2000;  29 211-215
• 210 Pedersen R S, Bistrup C. Etoposide: more effective and less bone-marrow toxic than standard immunosuppressive therapy in systemic vasculitis?.  Nephrol Dial Transplant. 1996;  11 1121-1123
• 211 Papo T, Le Thi Huong D, Wiederkehr J L, Woehl-Kremer B, Bletry O, Wechsler B. et al . Etoposide in Wegener's granulomatosis.  Rheumatology (Oxford). 1999;  38 473-475
• 212 Tatsis E, Schnabel A, Gross W L. Interferon-alpha treatment of four patients with the Churg-Strauss syndrome.  Ann Intern Med. 1998;  129 370-374
• 213 Stegmayr B G, Almroth G, Berlin G, Fehrman I, Kurkus J, Norda R. et al . Plasma exchange or immunoadsorption in patients with rapidly progressive crescentic glomerulonephritis. A Swedish multi-center study.  Int J Artif Organs. 1999;  22 81-87
• 214 Tyndall A, Fassas A, Passweg J, Ruiz de Elvira C, Attal M, Brooks P. et al . Autologous haematopoietic stem cell transplants for autoimmune disease - feasibility and transplant-related mortality. Autoimmune Disease and Lymphoma Working Parties of the European Group for Blood and Marrow Transplantation, the European League Against Rheumatism and the International Stem Cell Project for Autoimmune Disease.  Bone Marrow Transplant. 1999;  24 729-734
• 215 Ogawa T, Taguchi T, Tanaka Y, Ikeguchi K, Nakano I. Intravenous immunoglobulin therapy for diabetic amyotrophy.  Intern Med. 2001;  40 349-352
• 216 Schrader M, Heicappell R, Müller M, Straub B, Miller K. Impact of chemotherapy on male fertility.  Onkologie. 2001;  24 326-330
• 217 Janssen N M, Genta M S. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation.  Arch Intern Med. 2000;  160 610-619
• 218 Sommer C. Symptomatic treatment of painful neuropathies. In: Sommer C (ed.). Pain in peripheral Nerve Disease. Basel: Karger 2001: 171-195
• 219 Nitta Y, Sobue G. Progressive systemic sclerosis associated with multiple mononeuropathy.  Dermatology. 1996;  193 22-26
• 220 Said G. Vasculitic neuropathy.  Baillieres Clin Neurol. 1995;  4 489-503
• 221 Peyronnard J M, Charron L, Beaudet F, Couture F. Vasculitic neuropathy in rheumatoid disease and Sjogren syndrome.  Neurology. 1982;  32 839-845
• 222 Feinglass E J, Arnett F C, Dorsch C A, Zizic T M, Stevens M B. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease.  Medicine (Baltimore). 1976;  55 323-339
• 223 Enevoldson T P, Wiles C M. Severe vasculitic neuropathy in systemic lupus erythematosus and response to cyclophosphamide.  J Neurol Neurosurg Psychiatry. 1991;  54 468-469
• 224 Fuller G N, Jacobs J M, Guiloff R J. Nature and incidence of peripheral nerve syndromes in HIV infection.  J Neurol Neurosurg Psychiatry. 1993;  56 372-381
• 225 Meriggioli M N, Morgenlander J C. Peripheral neuropathy and connective tissue disease. Watch for this twosome when hunting for a diagnosis.  Postgrad Med. 1997;  102 65-68, 71, 75