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“A merry heart doeth good like medicine.”

Socrates (469 B.C.–399 B.C.)

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Objectives

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On completion of this chapter, the student/practitioner will be able to:

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  • Develop an evidenced-based understanding of vasculitic, connective tissue, and spondyloarthropathic disorders as they relate to neuropathic signs and symptoms.

  • Identify on the physical examination potential neuropathic impairments related to vasculitic, connective tissue, and seronegative spondyloarthropathic disorders.

  • Develop a goal-oriented treatment plan for vasculitic, connective tissue, and seronegative spondyloarthropathic disorders.

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Key Terms

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  • Connective tissue disorders

  • Seronegative spondyloarthropathies

  • Vasculitic disorders

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Introduction

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The group of disorders comprising the vasculitides, connective tissue disorders, and seronegative spondyloarthropathies produces impairments related to most corporal systems, including respiratory, musculoskeletal, renal, cardiac, gastrointestinal, integument, and neurological. Vasculitic disorders affect primarily the vasculature resulting in “downstream” impairments related to perfusion issues and inflammation. On a system-wide scale, connective tissue disorders and seronegative spondyloarthropathies (SpAs) affect multiple tissue types. In many of these disorders, peripheral neuropathy is a common, although often secondary, manifestation. In addition, many of the interventions currently indicated for these disorders—immunomodulating drugs, biologicals, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)—may produce signs and symptoms that may require rehabilitation services interventions.

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Vasculitic Diseases

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Knowledge of vasculitic neuropathy is important for clinicians for three reasons: (1) Once diagnosed, vasculitic diseases are often treatable with immunosuppressive medications and therapies, especially when the disease is identified in its early stages. (2) Neuropathy is often the presenting sign of vasculitic disease. (3) The neuropathic signs are often present in the well-recognized pattern of multifocal motor, sensory, and autonomic neuropathy.

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Vasculitis is a local or systemic inflammation of the vasculature, including the arteries, capillaries, and veins. Typically, lymph vessels are spared. Inflammation of the blood vessels is characterized by leukocyte and macrophage infiltration of the vessel walls resulting in edema, angiogenesis, scarring and potential vascular necrosis, clot, and hemorrhage.13 Local inflammation, if of sufficient magnitude, may produce systemic signs of inflammation, such as cachexia, anemia of chronic disease, depression, and sickness behavior.46

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Although there are many theories regarding the etiology of vasculitic disorders, the exact pathogenesis is not fully understood. Some vasculitides are thought to be an allergic-type reaction, and others are thought to be autoimmune-mediated. This inflammation and the body's subsequent inflammatory cascade reactions may cause the vessels to become weakened and may impair the integrity of the vessel walls, which can prevent adequate flow of blood through the affected vessels. Ischemia of the organ and body tissues perfused by the blood supply may result. The resultant ischemia is the cause for many of the problems that the different types of vasculitis can cause.79

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Vasculitides can also be secondary to other conditions (secondary vasculitis), such as infections, malignancy, reactions to certain medications, complications after organ ...

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