Evaluation of relationship between peripheral neuropathy and digital ulcer formation in patients with systemic sclerosis
PDF
Cite
Share
Request
Original Article
P: 76-82
December 2020

Evaluation of relationship between peripheral neuropathy and digital ulcer formation in patients with systemic sclerosis

J Turk Soc Rheumatol 2020;12(3):76-82
1. Hacettepe Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Romatoloji Bilim Dalı, Ankara, Türkiye
No information available.
No information available
Received Date: 09.11.2020
Accepted Date: 30.11.2020
Publish Date: 21.12.2020
PDF
Cite
Share
Request

ABSTRACT

Objective:

Quantitative Sensory testing (QST) is a non-invasive method used in the diagnosis and classification of peripheral neuropathies. This study aimed to evaluate peripheral small and large fibers involvement by QST in patients with systemic sclerosis and to evaluate its relationship with digital ulcer formation.

Methods:

Patients with systemic sclerosis who applied to the rheumatology unit between April and September 2013 were included in the study. All patients were evaluated with a detailed medical history and physical examination. Imaging and laboratory results and information on organ involvements were obtained from hospital files. Patients were evaluated with QST to determine large and small fibers involvement.

Results:

The study was conducted with 50 (92% female) systemic sclerosis patients. The mean age was 47±12 years, the mean disease duration was 11.3±7.2 years. Sixty-six percent (n=33) of the patients had a history of digital ulcer and/or pitting scar. In QST evaluation, 84% (n=42) of patients had abnormality in vibration and/or cold detection thresholds. The number of patients with upper extremity vibration detection threshold abnormality was higher than that of the patients with lower extremity abnormality (74% vs 40%). There was no statistically significant difference between the groups with and without QST abnormalities regarding the clinical features including digital ulcer/pitting scar history (p>0.05 for all).

Conclusion:

In this study, significant number of patients with systemic sclerosis had QST abnormality, which is evident in the vibration detection thresholds. Longitudinal studies in early systemic sclerosis patients are needed to determine the clinical importance of QST.

References

1Bhattacharyya S, Wei J, Varga J. Understanding fibrosis in systemic sclerosis: shifting paradigms, emerging opportunities. Nat Rev Rheumatol 2011;8:42-54.
2Denton CP, Khanna D. Systemic sclerosis. Lancet 2017;390:1685-99.
3Knupp-Oliveira S, Cerinic MM. Polyneuropathy as initial manifestation of systemic sclerosis (scleroderma). Scand J Rheumatol 1999;28:260-1.
4Poncelet AN, Connolly MK. Peripheral neuropathy in scleroderma. Muscle Nerve 2003;28:330-5.
5Ferri C, Valentini G, Cozzi F, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine (Baltimore) 2002;81:139-53.
6Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology (Oxford) 2009;48 Suppl 3:iii19-24.
7Prete M, Fatone MC, Favoino E, Perosa F. Raynaud’s phenomenon: from molecular pathogenesis to therapy. Autoimmun Rev 2014;13:655-67.
8Malandrini A, Selvi E, Villanova M, et al. Autonomic nervous system and smooth muscle cell involvement in systemic sclerosis: ultrastructural study of 3 cases. J Rheumatol 2000;27:1203-6.
9Gruener G, Dyck PJ. Quantitative sensory testing: methodology, applications, and future directions. J Clin Neurophysiol 1994;11:568-83.
10Shy ME, Frohman EM, So YT, et al. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2003;60:898-904.
11Dyck PJ, O’Brien PC, Kosanke JL, Gillen DA, Karnes JL. A 4, 2, and 1 stepping algorithm for quick and accurate estimation of cutaneous sensation threshold. Neurology 1993;43:1508-12.
12Dyck PJ, Zimmerman IR, O’Brien PC, et al. Introduction of automated systems to evaluate touch-pressure, vibration, and thermal cutaneous sensation in man. Ann Neurol 1978;4:502-10.
13Chong PS, Cros DP. Technology literature review: quantitative sensory testing. Muscle Nerve 2004;29:734-47.
14Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281-9.
15Bakkers M, Faber CG, Hoeijmakers JG, Lauria G, Merkies IS. Small fibers, large impact: quality of life in small-fiber neuropathy. Muscle Nerve 2014;49:329-36.
16Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 1980;23:581-90.
17Dyck PJ, Litchy WJ, Lehman KA, Hokanson JL, Low PA, O’Brien PC. Variables influencing neuropathic endpoints: the Rochester Diabetic Neuropathy Study of Healthy Subjects. Neurology 1995;45:1115-21.
18O’Brien PC, Dyck PJ. Procedures for setting normal values. Neurology 1995;45:17-23.
19Paik JJ, Mammen AL, Wigley FM, Shah AA, Hummers LK, Polydefkis M. Symptomatic and Electrodiagnostic Features of Peripheral Neuropathy in Scleroderma. Arthritis Care Res (Hoboken) 2016;68:1150-7.
20Amaral TN, Peres FA, Lapa AT, Marques-Neto JF, Appenzeller S. Neurologic involvement in scleroderma: a systematic review. Semin Arthritis Rheum 2013;43:335-47.
21Schady W, Sheard A, Hassell A, Holt L, Jayson MI, Klimiuk P. Peripheral nerve dysfunction in scleroderma. QJM 1991;80:661-75.
22Mete T, Aydin Y, Saka M, et al. Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy. Int J Endocrinol 2013;2013:821745.
23Bril V, Perkins BA. Comparison of vibration perception thresholds obtained with the Neurothesiometer and the CASE IV and relationship to nerve conduction studies. Diabet Med 2002;19:661-6.
24Manneschi LI, Del Rosso A, Milia AF, et al. Damage of cutaneous peripheral nervous system evolves differently according to the disease phase and subset of systemic sclerosis. Rheumatology (Oxford) 2005;44:607-13.
25Amanzi L, Braschi F, Fiori G, et al. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford) 2010;49:1374-82.
26Nadashkevich O, Davis P, Fritzler M, Kovalenko W. A randomized unblinded trial of cyclophosphamide versus azathioprine in the treatment of systemic sclerosis. Clin Rheumatol 2006;25:205-12.
27Caramaschi P, Volpe A, Pieropan S, et al. Cyclophosphamide treatment improves microvessel damage in systemic sclerosis. Clin Rheumatol 2009;28:391-5.
28Hietaharju A, Jantti V, Korpela M, Frey H. Nervous system involvement in systemic lupus erythematosus, Sjogren syndrome and scleroderma. Acta Neurol Scand 1993;88:299-308.
29Hietarinta M, Lassila O, Hietaharju A. Association of anti-U1RNP- and anti-Scl-70-antibodies with neurological manifestations in systemic sclerosis (scleroderma). Scand J Rheumatol 1994;23:64-7.
30Zaslansky R, Yarnitsky D. Clinical applications of quantitative sensory testing (QST). J Neurol Sci 1998;153:215-38.
Article is only available in PDF format. Show PDF
2024 ©️ Galenos Publishing House