What is your approach for treating mononeuritis multiplex in patients with ANCA vasculitis?

Mononeuritis multiplex related to ANCA associated vasculitis generally responds to treatment with rituximab, which would be my treatment of choice. Clinicians need to be aware that neurologic recovery can be very slow, and it is important to distinguish damage from ongoing active nerve inflammation. Close collaboration with a neurologist is essential for optimal patient care. Cyclophosphamide could be considered in the exceptional circumstance of lack of response to rituximab - but again, it would be essential to confirm a true lack of response (sometimes by nerve biopsy) rather than slow response to treatment/permanent nerve damage.