Hela G Zouari1,2, Abir Wahab1,3, Sophie Ng Wing Tin1,4,5, Damien Sène6, Jean-Pascal Lefaucheur1,7. 1. EA 4391, Faculty of Medicine, Paris-Est-Creteil University, Créteil, France. 2. Physiological Investigations, Habib Bourguiba University Hospital, Sfax, Tunisia. 3. Neurology Department, Henri Mondor University Hospital, AP-HP, Creteil, France. 4. Physiological Investigations & Sport Medicine, Avicenne Hospital, AP-HP, Bobign, France. 5. EA 2363, UFR SMBH, Paris_13 University, Bobigny, France. 6. Internal Medicine Department, Lariboisiere Hospital, AP-HP, Paris-7 University, Paris, France. 7. Clinical Neurophysiology, Henri Mondor University Hospital, AP-HP, Créteil, France.
Abstract
OBJECTIVE: We attempted to determine whether clinical features could differentiate painful small-fiber neuropathy related to primary Sj€ogren's syndrome (pSS-SFN) from idiopathic SFN (idio-SFN). METHODS: Validated clinical questionnaires and neurophysiological investigations specific for pain and SFN assessment were performed in 25 patients with pSS-SFN and 25 patients with idio-SFN. RESULTS: Patients with idio-SFN had more frequent severe burning sensations and higher mean anxiety scores and daily pain intensity compared to patients with pSSSFN. Conversely, patients with pSS-SFN had reduced electrochemical skin conductance measured by Sudoscan_, and almost half of them had the sensation of walking on cotton wool. CONCLUSION: Our results suggest that idio-SFN more specifically involved small sensory fibers than pSS-SFN, in which subtle dysfunction of larger sensory fibers and damage of distal autonomic sudomotor innervation may occur. A practical algorithm is proposed to help to differentiate SFN associated with pSS from idio-SFN, based on information very easy to obtain by clinical interview.
OBJECTIVE: We attempted to determine whether clinical features could differentiate painful small-fiber neuropathy related to primary Sj€ogren's syndrome (pSS-SFN) from idiopathic SFN (idio-SFN). METHODS: Validated clinical questionnaires and neurophysiological investigations specific for pain and SFN assessment were performed in 25 patients with pSS-SFN and 25 patients with idio-SFN. RESULTS:Patients with idio-SFN had more frequent severe burning sensations and higher mean anxiety scores and daily pain intensity compared to patients with pSSSFN. Conversely, patients with pSS-SFN had reduced electrochemical skin conductance measured by Sudoscan_, and almost half of them had the sensation of walking on cotton wool. CONCLUSION: Our results suggest that idio-SFN more specifically involved small sensory fibers than pSS-SFN, in which subtle dysfunction of larger sensory fibers and damage of distal autonomic sudomotor innervation may occur. A practical algorithm is proposed to help to differentiate SFN associated with pSS from idio-SFN, based on information very easy to obtain by clinical interview.