There is a secondary vasculitis, probably after anty-HB immune injection. Or probably after adjuvant in the vaccine.
If you are sure that you excluded cryoglobulinemia, primary sjogren's syndrome and ANCA-associated vasculitis and you have a sensorimotor neuropathy or mononeuritis multiplex you need to use high dose corticosteroids and cyclophosphamide, but if you have a pure sensorial neuropathy you might go milder and use methotrexate or azathioprine. Make sure you're not dealing with something like Guillame-Barre, AMSAN/AMAN or a painful post-viral plexopathy. Make sure you see small/medium size vasculitis on a biopsy. If "vasculitic neuropathy" is only a clinical diagnosis and there's no chance to do a biopsy IVIG and corticosteroids would be the safest way to go.
So far, the treatment involved 30g oral cyclophosphamide, followed by 15mg per week methotrexate and different doses of methylprednisolon. But since 10 years the disease is still active, unfortunatelly, however in a benign state.
10 years is a long time. Are you sure this is disease activity and not permanent/irreversible damage to the peripheral nervous system? Because permanent damage will not respond to immunosuppression. And how does the current disease status effect your patient's life?
After such a long period of time, "chronic" damage has to be assumed. I am treating my patients, in addition with immunosuppression, with anti-epileptics such as gabapentin or pregabalin, since this is a serious disease involvement.
Dear Sir, thank You for the answer. I have tried gabapentin, but it causes me all day sleepy, so I was unable to function normally ;) At this moment I get episcleritis with exfoliative cheilitis and because of some problems with gut, it is higly possibly, that it might be a collitis ulcerosa which is the basis of all problems. The colonoscopy will reaveal the situation and will see. The blood results are ok. But they are always ok, even when the flare is present. Best regards. Alex
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