Polyradiculoneuritis - is this an auto-immune disease

[sgrault]

Has anyone had experience of this issue which results in paralysis and if so what are the recommendations for rehab?

My agility trainer has a 10yr old Sheltie that has this currently

Regards

Sue

[Catherine]

I have no experience of this but there is a thread on this site that mentions it and in which Jo has posted some links that may be helpful:

The thread here: http://cimda.co.uk/smf/index.php?topic=898.msg8394#msg8394

and the two posts I have copied here:



A mixed update on Saba.

The good news is that she is regaining strength and has even managed to walk a few steps unaided today. It's wobbly and it's short lived but it is a long way from where she was a week ago. Her liver enzymes had halved last week from the very high levels and have almost halved again in today's blood results. She continues to eat, catch flies and loves her morning visit to the park to see her buddies.

The bad news is that we decided to measure the muscle enzyme last week as there is concern at the amount of muscle wastage we have seen with her. It was above 1700 whereas I gather the normal is 400. This week it is back to 1100. On this basis the specialist believes there is a muscle myopathy going on and has suggested we should be increasing the pred again. I'm reluctant to given the trend is improving, albeit not as strongly as we might like and pred is not going to help us in the fight against the polyradiculoneuritis. We have agreed to give it another week with just the 5mg pred daily plus the leflunomide.

I have two questions. Is there any reason other than yet another immune disease involving muscle myopathy that the CK result would be running high? The vet did mention the fact that she is basically full time recumbent might boost it a little but she didn't think as much as this.  The second question is, if we do face a muscle myopathy, are we just fighting a losing battle with IMPA, polyradiculoneuritis and muscle myopathy? Is it just too much to expect her to fight on three fronts?


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Re: Saba - 10 year old vizsla with IMPA

« Reply #44 on: January 27, 2017, 09:16:12 AM »

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Hi Rebecca

I am not a vet but my take on Saba's elevated CK and her muscle atrophy is this.

Since drastically reducing the preds you have seen an improvement in her strength, and her liver enzymes and CK enzymes have reduced.  One of the main causes of all three of these symptoms is overuse of corticosteroids (prednisolone). 

There is no doubt that Saba's prednisolone reduction regime was incredibly slow and even if she does have an additional muscle disease, polyradiculoneuritis, her drug history alone would suggest that these symptoms could reasonably be due to the high and prolonged doses of steroids. 

If you see the links below one of the causes of high CK is hyperadrenocorticism, which is Cushing's disease.  The fact that the CK and liver enzymes have reduced, in my opinion,  can only be due to the much reduced dose of prednisolone.

I think you have a lot to be happy about right now and if her body is given the chance to repair itself from the insult of the preds then I think (I hope ) you will see a much improved Saba soon.

I don't think you are losing this battle, I think you are just starting to win it.

Good luck

Jo


http://www.the-vet.net/DVMWiz/Vetlibrary/Lab-%20creatine_kinase.htm

http://researchonline.jcu.edu.au/9250/1/13_clinical_udpate_Drug_induced_muscle_disorders_published.pdf

[Jo CIMDA]

Hi

I am sorry that Sheltie has paralysis.  How is this being treated?

https://www.theanic.com/wp-content/uploads/2019/04/polyradiculoneuritis.pdf

Polyradiculoneuritis in the dog is not a common diagnosis and I understand that there is no specific test that will give a definitive diagnosis. 

The more commonly diagnosed  AI diseases that cause muscle weakness are, Myasthenia Gravis (MG) and  polymyositis. 

As there are no definitive tests for polyradiculoneuritis, and as it is an autoimmune disease that affects the nerves, causing weakness and paralysis, and is possibly similar to myasthenia gravis, I wonder if the vet is treating it with immunosuppressive drugs such as Leflunomide, Mycophenolate or Pyridostigmine Bromide? 

The usual and most go-to drug for treating AI disease is immunosuppressive doses of prednsiolone, but this is not recommended for treating diseases with muscle weakness because that is a side effect of the preds. Low doses of preds can be added to an immunosuppressive drug regimen but it is not used as the primary drug.

With an AI disease such as MG and polymyositis,  the primary cause has to be treated with immunosuppressive therapy (significantly suppressing the immune system to stop the destruction) but often with this type of AI disease mobility does not always return to 100%, this is why it is best to use immunosuppressive therapy as soon as possible, to stop further destruction and attempting to retain as much mobility as possible.

Depending on the dog's mobility, perhaps hydrotherapy can be given, even a treadmill but that would have to be assessed on an individual basis.

I would ask the vet if there is a possibility of this not being polyradiculoneuritis and whether treatment with one of the above drugs could be considered.

I hope things improve

Jo