Abstract
Background
To distinguish large (LFN) and small fiber neuropathies (SFN) in Sjögren's syndrome
(SS) requires electroneuromyography (EMG) first, but this is time-consuming and has
sometimes a limited accessibility, which can lead to a diagnostic delay. We aimed
to identify clinical features that could distinguish SFN from sensitive LFN in SS.
Methods
The study included patients with SS who were monitored in the internal medicine and
neurology departments at Angers University Hospital between 2010 and 2016, and who
were tested for suspected peripheral neuropathy. Patients with clinical motor involvement
were excluded. LFN diagnosis was based on EMG. SFN diagnosis was based on intraepidermal
nerve fiber density on skin biopsies in patients with no abnormality on EMG.
Results
LFN and SFN were diagnosed respectively in 22 (6.9%) and 17 (5.4%) patients among
317 patients with SS. Prevalence of anti-SSA antibodies was lower in the SFN group
compared to the LFN group (p=0.002). The types of paresthesia did not differ between
the 2 groups. After adjustment for age and sex, SFN was associated with dysautonomia
(p=0.01, OR 8.4 [CI 95%: 1.7-42.4]) and without length-dependent topography (p=0.03,
OR 0.2 [0.04-0.8] in comparison with the LFN group.
Conclusions
An association of non-length-dependent pattern and dysautonomia seems to predict the
absence of LFN in SS and encourages the search for SFN. In contrary, patients with
length-dependent involvement and without dysautonomia should be prioritized for EMG.
Keywords
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Article info
Publication history
Published online: May 27, 2020
Accepted:
May 3,
2020
Received:
December 2,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
