In a patient with strong serologic evidence of SLE presenting with isolated bilateral lower limb sensorimotor neuropathy, normal neuroimaging, and CSF, would you initiate cyclophosphamide with pulse-dose steroids upfront, or reserve escalation (e.g., plasma exchange or immunosuppressants) for cases refractory to steroids?
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1 Answers
Mednet Member
Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
This has been a dilemma for me for over several decades.
1. There is no good large data to guide us on this question. I do not think there is one correct answer.
2. All sensorimotor neuropathies are not created equally. I assume all other causes of sensorimotor polyneuropathy have been ruled out. Howe...