Prognosis
The prognosis of patients with MNM depends on the underlying aetiology. There are two important factors:
Overall mortality and morbidity due to involvement of other organ systems or complications of MNM
Disability related to incomplete recovery of peripheral nerves after MNM.
Overall mortality in MNM is not known but is likely to depend on the underlying aetiology. Systemic necrotising vasculitis of all types appears to be more aggressive, with a worse prognosis than non-systemic vasculitic neuropathy, although direct comparative data are not available.[6][7] Survival after 5 years for patients with systemic vasculitis is 70% to 90% with modern treatments. The corresponding survival rate for patients wih non-systemic vasculitic neuropathy is similar or better, at about 90%.[1] Mortality rates for patients with hepatitis C, hepatitis B, Lyme disease, leprosy, or sarcoidosis depend largely on effective treatment of the underlying disease and the involvement of other organ systems.
Outcomes in long-term survivors of non-systemic vasculitic neuropathy are approximately 14% with no symptoms; 67% with mild to moderate disability; 16% requiring assistance to walk (moderate to severe disability); and 3% non-ambulatory. It should be noted, however, that these data are not directly applicable to MNM, as they include all patients with a final diagnosis of non-systemic vasculitic neuropathy, which may present as a symmetrical, distal polyneuropathy.[74] The neurological disability seen in systemic vasculitis-associated neuropathy may be more severe.
Chronic pain is a frequent and often a disabling residual symptom following a vasculitic neuropathy.[1] Several classes of drugs are commonly used to manage these symptoms, including antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs, and, less commonly, opioids.
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