LONG TERM FOLLOW‐UP IN CRYOGLOBULINEMIC NEUROPATHY

Abstract

We evaluated the course of cryoglobulinemic neuropathy in a small series of patients in whom a long term follow‐up was available. Ten patients with polyneuropathy (8 cases) or multiple mononeuropathy (2 cases) associated with cryoglobulinemia type 2 (7 cases) or type 3 (3 cases) were reexamined after at least 5 years from the first observation (range of follow‐up, 5–14 years, median 9 years). All patients were positive for hepatitis C virus (HCV), but none had severe liver involvement, whereas renal involvement was severe in two cases. Two patients were treated with high‐dose prednisone for prolonged periods and one patient with alfa‐interferon for one year; the remaining patients were treated with low‐dose steroid and/or colchicine and cinnarizine.In the two patients with renal failure, neurological deterioration paralleled the worsening of general condition, and both eventually died after a disease course of less than ten years. In another patient, neurological condition was complicated by steroid‐induced diabetes, and stroke with left‐sided hemiparesis. In the remaining patients (including the patient treated with alfa‐interferon) neurological condition was unchanged, or mildly deteriorated without variation in the Rankin score, although neurophysiological indexes, and in particular amplitude of sensory action potentials, tended to worsen.We conclude that in a number of cases cryoglobulinemic neuropathy may run an indolent course with mild or absent deterioration, and can be controlled without aggressive medication. However, in a minority of cases there may be a malignant course, especially when systemic manifestations of the disease are prominent.