BRAIN and NERVE－神経研究の進歩68巻3号

2016年03月発行

特集 末梢神経の血管炎

血管炎性末梢神経障害のevidence-based treatment

著者： 古賀道明¹

所属機関： ¹山口大学大学院医学系研究科神経内科学

ページ範囲：P.243 - P.251

文献概要

血管炎性ニューロパチーの治療法に関する知見は限定的であり，全身性血管炎に倣い早期より複合的治療（副腎皮質ステロイド剤＋免疫抑制薬）を行うべきか明らかではない。少なくとも副腎皮質ステロイド剤による単剤治療では，半数近くの症例において効果が不十分とされている。早期に免疫抑制薬の併用が躊躇される際にも，比較的導入しやすい免疫グロブリン静注療法の併用などの治療オプションを早期から活用する工夫が期待される。

参考文献

1)Collins MP, Kissel J: Neuropathies with systemic vasculitis. Dyck PJ, Thomas PK (eds): Peripheral Neuropathy. 4th edition. Saunders, Philadelphia, 2005, pp2335-2404

2)Vrancken AF, Said G: Vasculitic neuropathy. Handb Clin Neurol 115: 463-483, 2013

3)Gwathmey KG, Burns TM, Collins MP, Dyck PJ: Vasculitic neuropathies. Lancet Neurol 13: 67-82, 2014

4)Blaes F: Diagnosis and therapeutic options for peripheral vasculitic neuropathy. Ther Adv Musculoskelet Dis 7: 45-55, 2015

5)Vrancken AF, Hughes RA, Said G, Wokke JH, Notermans NC: Immunosuppressive treatment for non-systemic vasculitic neuropathy. Cochrane Database Syst Rev 2007 Jan 24; (1): CD006050

6)Robson J, Doll H, Suppiah R, Flossmann O, Harper L, et al: Damage in the anca-associated vasculitides: long-term data from the European vasculitis study group (EUVAS) therapeutic trials. Ann Rheum Dis 74: 177-184, 2015

7)Walsh M, Mukhtyar C, Mahr A, Herlyn K, Luqmani R, et al: Health-related quality of life in patients with newly diagnosed antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res (Hoboken) 63: 1055-1061, 2011

8)Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, et al: Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients. Medicine (Baltimore) 75: 17-28, 1996

9)Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, et al: The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 90: 19-27, 2011

10)Suppiah R, Hadden RD, Batra R, Arden NK, Collins MP, et al: Peripheral neuropathy in ANCA-associated vasculitis: outcomes from the European Vasculitis Study Group trials. Rheumatology (Oxford) 50: 2214-2222, 2011

11)de la Sayette V, Macro M, Diraison P, Bertran F, Lechevalier B, et al: Acute necrotizing vasculitis (polyarteritis nodosa?) confined to the nerve with spontaneous recovery. Br J Rheumatol 34: 694-695, 1995

12)Mathew L, Talbot K, Love S, Puvanarajah S, Donaghy M: Treatment of vasculitic peripheral neuropathy: a retrospective analysis of outcome. QJM 100: 41-51, 2007

13)Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, et al: 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65: 1-11, 2013

14)Collins MP, Dyck PJ, Gronseth GS, Guillevin L, Hadden RD, et al: Peripheral Nerve Society Guideline on the classification, diagnosis, investigation, and immunosuppressive therapy of non-systemic vasculitic neuropathy: executive summary. J Peripher Nerv Syst 15: 176-184, 2010

15)Guillevin L, Mahr A, Callard P, Godmer P, Pagnoux C, et al: Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore) 84: 313-322, 2005

16)Lapraik C, Watts R, Bacon P, Carruthers D, Chakravarty K, et al: BSR and BHPR guidelines for the management of adults with ANCA associated vasculitis. Rheumatology (Oxford) 46: 1615-1616, 2007

17)Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, et al: EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 68: 310-317, 2009

18)Villa-Forte A: European League Against Rheumatism/European Vasculitis Study Group recommendations for the management of vasculitis. Curr Opin Rheumatol 22: 49-53, 2010

19)厚生労働省科学研究費補助金　難治性疾患克服事業「ANCA関連血管炎のわが国における治療法の確立のための多施設共同前向き臨床研究班」「難治性血管炎に関する調査研究班」「進行性腎障害に関する調査研究班」; 尾崎承一, 槇野博史, 松尾清一（編）: ANCA関連血管炎の診療ガイドライン. 2011　http://minds4.jcqhc.or.jp/minds/ANCA/anca.pdf

20)Jones RB, Tervaert JW, Hauser T, Luqmani R, Morgan MD, et al: Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med 363: 211-220, 2010

21)Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, et al: Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 363: 221-232, 2010

22)Specks U, Merkel PA, Seo P, Spiera R, Langford CA, et al: Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med 369: 417-427, 2013

23)Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, et al: Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med 371: 1171-1180, 2014

24)Charles P, Bienvenu B, Bonnotte B, Gobert P, Godmer P, et al: Rituximab: Recommendations of the French Vasculitis Study Group (FVSG) for induction and maintenance treatments of adult, antineutrophil cytoplasm antibody-associated necrotizing vasculitides. Presse Med 42: 1317-1330, 2013

25)Collins MP, Periquet MI, Mendell JR, Sahenk Z, Nagaraja HN, et al: Nonsystemic vasculitic neuropathy: insights from a clinical cohort. Neurology 61: 623-630, 2003

26)Davies L, Spies JM, Pollard JD, McLeod JG: Vasculitis confined to peripheral nerves. Brain 119: 1441-1448, 1996

27)Hattori N, Ichimura M, Nagamatsu M, Li M, Yamamoto K, et al: Clinicopathological features of Churg-Strauss syndrome-associated neuropathy. Brain 122: 427-439, 1999

28)Danieli MG, Cappelli M, Malcangi G, Logullo F, Salvi A, et al: Long term effectiveness of intravenous immunoglobulin in Churg-Strauss syndrome. Ann Rheum Dis 63: 1649-1654, 2004

29)Danieli MG, Calcabrini L, Marchetti A, Calabrese V, Pettinari L, et al: Intravenous immunoglobulin treatment in autoimmune diseases. Recenti Prog Med 98: 322-326, 2007

30)Koike H, Akiyama K, Saito T, Sobue G, Research Group for IVIg for EGPA/CSS in Japan: Intravenous immunoglobulin for chronic residual peripheral neuropathy in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): a multicenter, double-blind trial. J Neurol 262: 752-759, 2015

31)Levy Y, Uziel Y, Zandman G, Rotman P, Amital H, et al: Response of vasculitic peripheral neuropathy to intravenous immunoglobulin. Ann N Y Acad Sci 1051: 779-786, 2005