Lupus, a chronic inflammatory disease, can be difficult to diagnose. The most common sign of Lupus, a facial rash, does not occur in all cases. Moreover, other signs and symptoms of Lupus are often vague and can mimic those of other diseases. There is no single test to diagnose lupus. In many cases, it takes months or years to determine a diagnosis of Lupus. Doctors must look to clinical criteria, and then conduct multiple tests to refine or confirm the diagnosis of Lupus.
With Lupus, the body’s immune system attacks the other parts of the body. As Lupus attacks the body, it can cause damage to the joints, skin, kidneys, heart, lungs, blood vessels and brain. According to researchers at Johns Hopkins, Lupus may also led to nerve degeneration, and peripheral neuropathy is a more common manifestation of systemic lupus erythematosus (SLE) than has been previously understood.
In a 25-year study of 2,097 patients, researchers at Johns Hopkins found a prevalence of 5.9% of peripheral neuropathy in patients with systemic lupus erythematosus (SLE). Of the patients with neuropathy, the neuropathy was directly attributable to SLE in about 67% of cases. Furthermore, the study showed 17.1% of these patients had small fiber neuropathy (SFN), which is especially significant as the American College of Rheumatology does not include SFN in their cases definitions of SLE.
The researchers used skin biopsies to confirm the diagnosis of SFN. This diagnostic test has been shown to have a very high diagnostic efficiency. In the case of SFN from SLE, skin biopsies was especially important as the typical “stocking and glove” distal pattern symptoms were not often present, with the majority of affected SLE patients had a highly unusual pattern of pain in the torso, face, thigh, and even the whole body. Only 5 of the 14 patients had the classic SFN symptoms, which typically begins as burning pain in the feet. In these patients, skin biopsies showed the most decrease in nerve fibers in the lower leg, consistent with axonal degeneration, as compared to patients with whole body distribution, where the nerve fiber decrease was more commonly found in the thigh, indicating degeneration of the dorsal root ganglia.
“Our findings reinforce that rheumatologists who care for patients with SLE should be aware of how to recognize and diagnose a small-fiber neuropathy, particularly since a small-fiber neuropathy may occur in the face of normal electrodiagnostic studies,” Birnbaum and colleagues observed.
The medical staff at US Neuropathy Centers are experts in cutting edge diagnostic procedures for neuropathy and the treatment of this condition. If you have any warning signs of nerve damage, we encourage you to contact one of our centers today!
Find one of our locations at www.usneuropathycenters.com.
The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
@US Neuropathy Centers, 2018
Source reference: Oomatia A, et al “Peripheral neuropathies in systemic lupus erythematosus: clinical features, disease associations, and immunological characteristics evaluated over a 25-year study period” Arthritis Rheum 2013; DOI: 10.1002/art.38302.