Corticosteroids neuropathy



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Corticosteroids (cortisone) are powerful anti-inflammatory drugs.

They are used to treat a wide variety of inflammatory diseases. Among those conditions are various inflammatory nerve conditions.

Chronic inflammatory polyneuropathy (CIP) is a neurologic disease characterized by progressive weakness and loss of sensation in the arms and legs. CIP is more common in young adults, and it affects men more than women. Symptoms include numbness and tingling in the fingers and toes; weakness in the arms and legs; muscle aching; loss of deep tendon reflexes; and fatigue.

CIP mimics Guillain-Barré syndrome, which appears quickly and generally improves on its own.

The course of CIP varies. Some patients have spontaneous recovery, while others may have multiple bouts with partial recovery in between relapses.

Tests used in diagnosis are history, physical exam, electromyography (EMG), nerve conduction, lumbar puncture (spinal tap), and laboratory tests.

Among the treatments used are corticosteroids, intravenous immunoglobulin, and plasmapheresis.

Physical therapy is helpful.

Another category of inflammatory neuropathy is that occurring with vasculitis due to polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematosus, giant cell (temporal) arteritis, Takayasu’s disease, Kawasaki disease, and Sjogren’s disease.

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Vasculitis is an inflammation of the blood vessels. Vasculitis may affect blood vessels of any type, size, or location, and can cause problems in any organ system, including the central and peripheral nervous system. Peripheral neuropathy may occur as a result of having vasculitis.

The most common cause of vasculitis is an immune reaction.

Symptoms and signs of vasculitis are: fatigue, muscle pain, numbness, tingling, pain in the jaw with chewing, headaches, stiffness, night sweats, tenderness in the temple, weight loss, anemia, fever, and loss of vision.

Other possible symptoms include a rash on the legs, inflammatory arthritis, behavioral changes, seizures, stroke, abdominal pain, and chest pain.

Diagnostic tests such as history, physical exam, electromyography (EMG), MRI, blood tests, and chest x-ray. In many instances biopsy is needed.

The choice of treatment for vasculitis depends on: the severity of the vasculitis; the health of the patient, and the particular type of vasculitis.

Drugs used include corticosteroids, immunosuppressive drugs like cyclophosphamide (Cytoxan) or azathioprine (Imuran), intravenous immunoglobulin (IVIG), and plasmapheresis (filtering blood).

Sarcoidosis is a chronic inflammatory disease that usually involves the lungs, but may affect other organ systems. It is characterized by granulomas, which are abnormal collections of inflamed cells, granulation tissue, and blood vessels.

In rare cases, sarcoidosis may affect the nervous system and cause neurological problems, including peripheral neuropathy. Granulomas can occur in the brain, spinal cord, cranial nerves, causing facial paralysis, and other symptoms of nerve damage, including peripheral neuropathy.

In most cases, sarcoidosis heals spontaneously. Patients with more severe cases may require treatment for long periods of time.

Symptoms and signs may include fatigue, weakness, weight loss, fever, night sweats, red irritated eyes, swollen lymph nodes, shortness of breath, chest pain, rash, blurred vision, and swollen, red, painful ankles. Patients may have numbness, tingling, and pain due to neuropathy.

Diagnostic tests include history, physical exam, EMG, chest x-ray, eye exam, pulmonary function (breathing) test, and laboratory tests. A special kind of blood test called the angiotensin converting enzyme may be ordered.

The treatment consists of non steroidal anti-inflammatory drugs, corticosteroids, sometimes other disease-modifying drugs, and physical therapy.

Cryoglobulinemia is a disease where antibodies clump together, under cool conditions. People with cryoglobulinemia experience symptoms such as numbness, and pain in the arms and legs, bleeding under the skin, and joint pain when exposed to cold conditions.

Cryoglobulins are associated with different diseases such as cancer, infections, autoimmune disorders, arthritis, vasculitis, kidney disease, hepatitis C virus infection, and peripheral neuropathy. More than 90% of people with cryoglobulinemia have hepatitis C infection. Treatment of the underlying hepatitis C virus infection may be an effective therapy for an associated peripheral neuropathy.

Symptoms and signs include weakness, fatigue, joint pain, easy bruising, pain in the hands and feet, numbness and tingling in the hands and feet, and Raynauds syndrome (a condition where the fingers and toes turn dead white).

History, physical exam, laboratory tests (including hepatitis C antigen and antibody), nerve conduction, and EMG may be ordered.

Treatment consists of corticosteroids, plasmapheresis, interferon, and immunosuppressive drugs.Additional measures also will include analgesics and physical and occupational therapy.




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