COMMENTARY

IVIg for Sjogren's Neuropathy: Worth the Price?

Kevin Deane, MD

Disclosures

January 17, 2013

Results, Conclusions, and Author Viewpoint

Results. The MRS improved in 8 patients, remained stable in 10 patients, and worsened in 1 patient. According to clinician assessment, all patients with sensorimotor, non-ataxic sensory neuropathy and conduction block improved; however, of the 9 patients with ataxic neuropathy, only 2 improved, 3 remained stable, and 4 worsened. Ten of 13 patients who were treated with steroids were able to lower their doses, presumably as a result of the IVIg. Only 1 patient discontinued IVIg because of an adverse effect (nausea), and no severe adverse effects, such as thrombosis or renal failure, were observed.

Conclusions. IVIg may be useful in treating patients whose SS-associated sensorimotor neuropathies are not caused by necrotizing vasculitis, although the benefit in patients with ataxic neuropathy seems to be reduced.

Viewpoint

These results suggest that IVIg may be useful in treating some neuropathic manifestations of SS, although the investigators' conclusions are limited as a result of the small sample and the retrospective, uncontrolled nature of the study. IVIg is expensive and has some toxicity, including risk for thrombosis and renal injury;[4] therefore, more data from controlled trials are needed before we can be certain of its precise role in treatment of SS-related neuropathy. Furthermore, clear guidelines on how to classify the various types of SS-related neuropathy and a better understanding of the underlying pathophysiologic mechanisms of SS-related neuropathy may help guide treatment.

Abstract

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