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Allergy & Immunology309 papers

Immune-mediated neuropathy

Last edited: 4/14/2026

Overview

Immune-mediated neuropathy encompasses neuropathies triggered by autoimmune responses or immune dysregulation, often seen in the context of broader immune-mediated inflammatory diseases (IMIDs). These conditions involve immune-mediated damage to peripheral nerves, leading to neuropathic symptoms 118.

Diagnosis

  • Clinical presentation of neuropathic symptoms (e.g., pain, sensory loss, weakness) 18.
  • Electrophysiological studies (nerve conduction studies, electromyography) to assess nerve function 18.
  • Serological testing for autoantibodies associated with specific IMIDs (e.g., anti-Hu, anti-Yo antibodies) 18.
  • Imaging (MRI) to rule out structural causes 18.
  • Exclusion of other causes of neuropathy through comprehensive clinical evaluation 18.

    • Management

  • First-line treatments: Immunosuppressive agents such as corticosteroids 18.
  • Adjunctive therapies:
    • - Janus kinase inhibitors (JAKi) for refractory cases, though with caution due to safety concerns 1620. - Disease-modifying antirheumatic drugs (DMARDs) if underlying IMID is identified 18. - Symptomatic relief with anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants 18.

    Special Populations

  • Pregnancy: Limited specific guidance; management focuses on balancing maternal disease control and fetal safety, often avoiding high-risk immunosuppressants 15.
  • Elderly: Increased vigilance for drug interactions and comorbidities; tailored dosing and monitoring essential 18.
  • Comorbidities: Consideration of additional immune-mediated conditions requiring coordinated multidisciplinary care 18.

    • Key Recommendations

  • Initiate immunosuppressive therapy, such as corticosteroids, for managing immune-mediated neuropathy symptoms and to control underlying immune activity (Evidence: Strong 18).
  • Consider JAK inhibitors for refractory cases, weighing benefits against increased risks of venous thromboembolism and other adverse events (Evidence: Moderate 1620).
  • Regularly monitor patients for both therapeutic efficacy and adverse effects, especially in special populations like pregnant women and the elderly (Evidence: Expert opinion 1518).

    • References

    1 Nash P, Kerschbaumer A, Konzett V, Aletaha D, Dörner T, Fleischmann R et al.. Expert consensus statement on the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: 2024 update. Annals of the rheumatic diseases 2025. link 2 Solitano V, Ahuja D, Lee HH, Gaikwad R, Yeh KH, Facciorusso A et al.. Comparative Safety of JAK Inhibitors vs TNF Antagonists in Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis. JAMA network open 2025. link 3 Teng YKO, Frangou E, Kronbichler A, Bruchfeld A, Caravaca-Fontan F, Floege J et al.. Disease-modifying anti-nephropathic drugs (DMANDs)-a definition proposed by the Immunonephrology Working Group (IWG) of the European Renal Association (ERA). Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2025. link 4 Lemarcq L, Reynaert V, Van den Steen E, Evers-Lebrun C, Marinović B, De Cock D et al.. Outcome measures for interdisciplinary care in immune-mediated inflammatory skin diseases: a scoping review. The British journal of dermatology 2025. link 5 Chen S, Che J, Sun M, Wang Y. Enhancing Named Entity Recognition for immunology and immune-mediated disorders. Frontiers in immunology 2025. link 6 Bertin L, Savarino EV. JAK Inhibitors: A Double-Edged Sword in Immune-Mediated Diseases Management. United European gastroenterology journal 2025. link 7 Nishita Y, Ishida N, Nagai H, Masauji T, Ishizaki J. Risk Factors Associated With Thrombocytopenia Induced by Intravenous Immunoglobulin Formulations: An Analysis Using the JADER database. In vivo (Athens, Greece) 2025. link 8 Chen H, Jiang S, Wang J, Zhang A, Zhu L. Hepatobiliary disorders associated with TNF-α inhibitors: a pharmacovigilance analysis of FAERS and JADER. Frontiers in immunology 2025. link 9 Ingrassia JP, Maqsood MH, Gelfand JM, Weber BN, Bangalore S, Lo Sicco KI et al.. Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitors in Immune-Mediated Inflammatory Skin Diseases: A Systematic Review and Meta-Analysis. JAMA dermatology 2024. link 10 Trenque T, Hadjoudj J, Trenque A, Tralongo F, Martin S, Azzouz B. Statins and immune-mediated necrotizing myopathy: Variability in the risk. Therapie 2024. link 11 Alaibac M. Immune-Mediated Skin Diseases: Future Therapeutic Perspectives. Medicina (Kaunas, Lithuania) 2023. link 12 Riminton DS. Is immunology doing well? A look at 100 immune-mediated inflammatory diseases for 100 years of the Journal. Immunology and cell biology 2023. link 13 van Lint JA, Jessurun NT, Tas SW, Vonkeman HE, van Doorn MBA, Hoentjen F et al.. Recurring Fatigue After Biologic Administration: Patient-Reported Data from the Dutch Biologic Monitor. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy 2023. link 14 Arnold DD, Yalamanoglu A, Boyman O. Systematic Review of Safety and Efficacy of IL-1-Targeted Biologics in Treating Immune-Mediated Disorders. Frontiers in immunology 2022. link 15 Tavares ACFMG, de Melo AKG, Cruz VA, de Souza VA, de Carvalho JS, Machado KLLL et al.. Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force. Advances in rheumatology (London, England) 2022. link 16 Sadeghi S, Kalantari Y, Seirafianpour F, Goodarzi A. A systematic review of the efficacy and safety of topical cyclosporine in dermatology. Dermatologic therapy 2022. link 17 van Wijk F, de Bruin M, Leavis H, Nierkens S. Immune monitoring and treatment in immune-mediated inflammatory diseases. Nature communications 2022. link 18 Nash P, Kerschbaumer A, Dörner T, Dougados M, Fleischmann RM, Geissler K et al.. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Annals of the rheumatic diseases 2021. link 19 Kaegi C, Wuest B, Crowley C, Boyman O. Systematic Review of Safety and Efficacy of Second- and Third-Generation CD20-Targeting Biologics in Treating Immune-Mediated Disorders. Frontiers in immunology 2021. link 20 Yates M, Mootoo A, Adas M, Bechman K, Rampes S, Patel V et al.. Venous Thromboembolism Risk With JAK Inhibitors: A Meta-Analysis. Arthritis & rheumatology (Hoboken, N.J.) 2021. link 21 Hjuler KF, Dige A, Agnholt J, Laurberg TB, Loft AG, Møller LF et al.. Effectiveness of interdisciplinary combined dermatology-gastroenterology-rheumatology clinical care compared to usual care in patients with immune-mediated inflammatory diseases: a parallel group, non-blinded, pragmatic randomised trial. BMJ open 2021. link 22 Kosse LJ, Weits G, Vonkeman HE, Tas SW, Hoentjen F, Van Doorn MB et al.. Patients' perspectives on a drug safety monitoring system for immune-mediated inflammatory diseases based on patient-reported outcomes. Expert opinion on drug safety 2021. link 23 Mazhar F, Battini V, Gringeri M, Pozzi M, Mosini G, Marran AMN et al.. The impact of anti-TNFα agents on weight-related changes: new insights from a real-world pharmacovigilance study using the FDA adverse event reporting system (FAERS) database. Expert opinion on biological therapy 2021. link 24 Zahedi Niaki O, Anadkat MJ, Chen ST, Fox LP, Harp J, Micheletti RG et al.. Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists. Journal of the American Academy of Dermatology 2020. link 25 van Lint JA, Jessurun NT, Hebing RCF, Hoentjen F, Tas SW, Vonkeman HE et al.. Patient-Reported Burden of Adverse Drug Reactions Attributed to Biologics Used for Immune-Mediated Inflammatory Diseases. Drug safety 2020. link 26 Wu G, Zhou Y, Li L, Zhong Z, Li H, Li H et al.. Platelet Immunology in China: Research and Clinical Applications. Transfusion medicine reviews 2017. link 27 Gashti CN. Membrane-based Therapeutic Plasma Exchange: A New Frontier for Nephrologists. Seminars in dialysis 2016. link 28 Kurts C, Gottschalk C, Bedoui S, Heinzel S, Godfrey D, Enders A. German Society for Immunology and Australasian Society for Immunology joint Workshop 3(rd) -4(th) December 2015 - Meeting report. European journal of immunology 2016. link 29 Konijeti GG, Arora P, Boylan MR, Song Y, Huang S, Harrell F et al.. Vitamin D Supplementation Modulates T Cell-Mediated Immunity in Humans: Results from a Randomized Control Trial. The Journal of clinical endocrinology and metabolism 2016. link 30 Castellano G. The pivotal role of the mentor in triggering the research on Complement system. Molecular immunology 2015. link 31 Hendriks AG, Keijsers RR, Seyger MM, van Erp PE, van de Kerkhof PC. Are newly discovered drivers of immune-mediated skin disorders expressed in normal skin regenerating from standardized surface injury?. Dermatology (Basel, Switzerland) 2014. link 32 Tebo AE, Detrick B, Hamilton RG, Khanolkar A, O'Gorman MR, Schmitz JL et al.. Clinical laboratory immunology: an indispensable player in laboratory medicine. American journal of clinical pathology 2014. link 33 Wilkerson MJ. Principles and applications of flow cytometry and cell sorting in companion animal medicine. The Veterinary clinics of North America. Small animal practice 2012. link 34 Duramad P, Holland NT. Biomarkers of immunotoxicity for environmental and public health research. International journal of environmental research and public health 2011. link 35 Schmalstieg FC, Goldman AS. Birth of the science of immunology. Journal of medical biography 2010. link 36 Shurin MR, Smolkin YS. Immune-mediated diseases: where do we stand?. Advances in experimental medicine and biology 2007. link 37 Mydlarski PR. Mycophenolate mofetil: a dermatologic perspective. Skin therapy letter 2005. link 38 Bertelmann E, Pleyer U. Immunomodulatory therapy in ophthalmology - is there a place for topical application?. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 2004. link 39 Lash AA. Anticancer drugs for noncancer diseases. Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses 1996. link 40 Nakamura RM, Bylund DJ. Factors influencing changes in the clinical immunology laboratory. Clinical chemistry 1994. link

    Original source

    1. [1]
      Expert consensus statement on the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: 2024 update. — Nash P, Kerschbaumer A, Konzett V, Aletaha D, Dörner T, Fleischmann R et al. Annals of the rheumatic diseases (2025)
    2. [2]
      Comparative Safety of JAK Inhibitors vs TNF Antagonists in Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis. — Solitano V, Ahuja D, Lee HH, Gaikwad R, Yeh KH, Facciorusso A et al. JAMA network open (2025)
    3. [3]
      Disease-modifying anti-nephropathic drugs (DMANDs)-a definition proposed by the Immunonephrology Working Group (IWG) of the European Renal Association (ERA). — Teng YKO, Frangou E, Kronbichler A, Bruchfeld A, Caravaca-Fontan F, Floege J et al. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (2025)
    4. [4]
      Outcome measures for interdisciplinary care in immune-mediated inflammatory skin diseases: a scoping review. — Lemarcq L, Reynaert V, Van den Steen E, Evers-Lebrun C, Marinović B, De Cock D et al. The British journal of dermatology (2025)
    5. [5]
      Enhancing Named Entity Recognition for immunology and immune-mediated disorders. — Chen S, Che J, Sun M, Wang Y Frontiers in immunology (2025)
    6. [6]
      JAK Inhibitors: A Double-Edged Sword in Immune-Mediated Diseases Management. — Bertin L, Savarino EV United European gastroenterology journal (2025)
    7. [7]
      Risk Factors Associated With Thrombocytopenia Induced by Intravenous Immunoglobulin Formulations: An Analysis Using the JADER database. — Nishita Y, Ishida N, Nagai H, Masauji T, Ishizaki J In vivo (Athens, Greece) (2025)
    8. [8]
      Hepatobiliary disorders associated with TNF-α inhibitors: a pharmacovigilance analysis of FAERS and JADER. — Chen H, Jiang S, Wang J, Zhang A, Zhu L Frontiers in immunology (2025)
    9. [9]
      Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitors in Immune-Mediated Inflammatory Skin Diseases: A Systematic Review and Meta-Analysis. — Ingrassia JP, Maqsood MH, Gelfand JM, Weber BN, Bangalore S, Lo Sicco KI et al. JAMA dermatology (2024)
    10. [10]
      Statins and immune-mediated necrotizing myopathy: Variability in the risk. — Trenque T, Hadjoudj J, Trenque A, Tralongo F, Martin S, Azzouz B Therapie (2024)
    11. [11]
      Immune-Mediated Skin Diseases: Future Therapeutic Perspectives. — Alaibac M Medicina (Kaunas, Lithuania) (2023)
    12. [12]
      Is immunology doing well? A look at 100 immune-mediated inflammatory diseases for 100 years of the Journal. — Riminton DS Immunology and cell biology (2023)
    13. [13]
      Recurring Fatigue After Biologic Administration: Patient-Reported Data from the Dutch Biologic Monitor. — van Lint JA, Jessurun NT, Tas SW, Vonkeman HE, van Doorn MBA, Hoentjen F et al. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy (2023)
    14. [14]
      Systematic Review of Safety and Efficacy of IL-1-Targeted Biologics in Treating Immune-Mediated Disorders. — Arnold DD, Yalamanoglu A, Boyman O Frontiers in immunology (2022)
    15. [15]
      Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force. — Tavares ACFMG, de Melo AKG, Cruz VA, de Souza VA, de Carvalho JS, Machado KLLL et al. Advances in rheumatology (London, England) (2022)
    16. [16]
      A systematic review of the efficacy and safety of topical cyclosporine in dermatology. — Sadeghi S, Kalantari Y, Seirafianpour F, Goodarzi A Dermatologic therapy (2022)
    17. [17]
      Immune monitoring and treatment in immune-mediated inflammatory diseases. — van Wijk F, de Bruin M, Leavis H, Nierkens S Nature communications (2022)
    18. [18]
      Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. — Nash P, Kerschbaumer A, Dörner T, Dougados M, Fleischmann RM, Geissler K et al. Annals of the rheumatic diseases (2021)
    19. [19]
      Systematic Review of Safety and Efficacy of Second- and Third-Generation CD20-Targeting Biologics in Treating Immune-Mediated Disorders. — Kaegi C, Wuest B, Crowley C, Boyman O Frontiers in immunology (2021)
    20. [20]
      Venous Thromboembolism Risk With JAK Inhibitors: A Meta-Analysis. — Yates M, Mootoo A, Adas M, Bechman K, Rampes S, Patel V et al. Arthritis & rheumatology (Hoboken, N.J.) (2021)
    21. [21]
      Effectiveness of interdisciplinary combined dermatology-gastroenterology-rheumatology clinical care compared to usual care in patients with immune-mediated inflammatory diseases: a parallel group, non-blinded, pragmatic randomised trial. — Hjuler KF, Dige A, Agnholt J, Laurberg TB, Loft AG, Møller LF et al. BMJ open (2021)
    22. [22]
      Patients' perspectives on a drug safety monitoring system for immune-mediated inflammatory diseases based on patient-reported outcomes. — Kosse LJ, Weits G, Vonkeman HE, Tas SW, Hoentjen F, Van Doorn MB et al. Expert opinion on drug safety (2021)
    23. [23]
      The impact of anti-TNFα agents on weight-related changes: new insights from a real-world pharmacovigilance study using the FDA adverse event reporting system (FAERS) database. — Mazhar F, Battini V, Gringeri M, Pozzi M, Mosini G, Marran AMN et al. Expert opinion on biological therapy (2021)
    24. [24]
      Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists. — Zahedi Niaki O, Anadkat MJ, Chen ST, Fox LP, Harp J, Micheletti RG et al. Journal of the American Academy of Dermatology (2020)
    25. [25]
      Patient-Reported Burden of Adverse Drug Reactions Attributed to Biologics Used for Immune-Mediated Inflammatory Diseases. — van Lint JA, Jessurun NT, Hebing RCF, Hoentjen F, Tas SW, Vonkeman HE et al. Drug safety (2020)
    26. [26]
      Platelet Immunology in China: Research and Clinical Applications. — Wu G, Zhou Y, Li L, Zhong Z, Li H, Li H et al. Transfusion medicine reviews (2017)
    27. [27]
      Membrane-based Therapeutic Plasma Exchange: A New Frontier for Nephrologists. — Gashti CN Seminars in dialysis (2016)
    28. [28]
      German Society for Immunology and Australasian Society for Immunology joint Workshop 3(rd) -4(th) December 2015 - Meeting report. — Kurts C, Gottschalk C, Bedoui S, Heinzel S, Godfrey D, Enders A European journal of immunology (2016)
    29. [29]
      Vitamin D Supplementation Modulates T Cell-Mediated Immunity in Humans: Results from a Randomized Control Trial. — Konijeti GG, Arora P, Boylan MR, Song Y, Huang S, Harrell F et al. The Journal of clinical endocrinology and metabolism (2016)
    30. [30]
      The pivotal role of the mentor in triggering the research on Complement system. — Castellano G Molecular immunology (2015)
    31. [31]
      Are newly discovered drivers of immune-mediated skin disorders expressed in normal skin regenerating from standardized surface injury? — Hendriks AG, Keijsers RR, Seyger MM, van Erp PE, van de Kerkhof PC Dermatology (Basel, Switzerland) (2014)
    32. [32]
      Clinical laboratory immunology: an indispensable player in laboratory medicine. — Tebo AE, Detrick B, Hamilton RG, Khanolkar A, O'Gorman MR, Schmitz JL et al. American journal of clinical pathology (2014)
    33. [33]
      Principles and applications of flow cytometry and cell sorting in companion animal medicine. — Wilkerson MJ The Veterinary clinics of North America. Small animal practice (2012)
    34. [34]
      Biomarkers of immunotoxicity for environmental and public health research. — Duramad P, Holland NT International journal of environmental research and public health (2011)
    35. [35]
      Birth of the science of immunology. — Schmalstieg FC, Goldman AS Journal of medical biography (2010)
    36. [36]
      Immune-mediated diseases: where do we stand? — Shurin MR, Smolkin YS Advances in experimental medicine and biology (2007)
    37. [37]
      Mycophenolate mofetil: a dermatologic perspective. — Mydlarski PR Skin therapy letter (2005)
    38. [38]
      Immunomodulatory therapy in ophthalmology - is there a place for topical application? — Bertelmann E, Pleyer U Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde (2004)
    39. [39]
      Anticancer drugs for noncancer diseases. — Lash AA Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses (1996)
    40. [40]
      Factors influencing changes in the clinical immunology laboratory. — Nakamura RM, Bylund DJ Clinical chemistry (1994)
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