Small fiber neuropathy and related factors in patients with systemic lupus erythematosus; the results of cutaneous silent period and skin biopsy

Tekatas, Aslan; Tekatas, Demet Deniz; Solmaz, Volkan; Karaca, Turan; Pamuk, Ömer Nurı

doi:10.1186/s42358-020-00133-9

Cited by 11 publications

(8 citation statements)

References 37 publications

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“…In a recent study, both the cutaneous silent period and IENFD did not differ between patients with and without NP-SLE. 12 We also show no difference in corneal nerve parameters between patients with and without NP-SLE or lupus nephritis. The lack of difference in corneal nerve parameters may indicate different mechanisms underlying these other major prognostic manifestations in patients with SLE.…”

Section: Discussionmentioning

confidence: 45%

“… 6 There is a growing body of evidence demonstrating a significant subclinical small fiber neuropathy in patients with SLE. 7 – 12 Small fiber neuropathy is typically diagnosed from neuropathic symptoms and signs alongside an objective measure of small fiber damage by evaluating warm or cold sensory thresholds or intraepidermal nerve fiber density (IENFD). 13 However, sensory threshold testing can be subjective and variable and skin biopsy is invasive, precluding their use for the diagnosis of small fiber neuropathy in SLE.…”

Section: Introductionmentioning

confidence: 99%

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Subclinical Corneal Nerve Fiber Damage and Immune Cell Activation in Systemic Lupus Erythematosus: A Corneal Confocal Microscopy Study

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et al. 2021

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study was to evaluate the utility of corneal confocal microscopy (CCM) in identifying small nerve fiber damage and immune cell activation in patients with systemic lupus erythematosus (SLE). Methods This cross-sectional comparative study included 39 consecutive patients with SLE and 30 healthy control participants. Central corneal sensitivity was assessed using a Cochet-Bonnet contact corneal esthesiometer and a laser scanning CCM (Heidelberg, Germany) was used to quantify corneal nerve fiber density (CNFD), nerve branch density (CNBD), nerve fiber length (CNFL), and Langerhans cell (LC) density. Results Age was comparable among patients with SLE (33.7 ± 12.7) and controls (35.0 ± 13.7 years, P = 0.670) and the median duration of disease was 3.0 years (2.0–10.0 years). CNBD ( P = 0.003) and CNFL ( P = 0.019) were lower and mature LC density ( P = 0.002) was higher, but corneal sensitivity ( P = 0.178) and CNFD ( P = 0.198) were comparable in patients with SLE compared with controls. The SELENA-SLEDAI score correlated with CNFD (ρ = −0.319, P = 0.048) and CNFL (ρ = −0.373, P = 0.019), and the total and immature LC densities correlated with CNBD (ρ = −0.319. P = 0.048, and ρ = −0.328, P = 0.041, respectively). Immature LC density was higher ( P = 0.025), but corneal sensitivity and nerve fiber parameters were comparable between patients with (33%) and without neuropsychiatric symptoms and SLE. Conclusions Corneal confocal microscopy identifies distal corneal nerve fiber loss and increased immune cell density in patients with SLE and corneal nerve loss was associated with disease activity. Translational Relevance Corneal confocal microscopy may enable the detection of subclinical corneal nerve loss and immune cell activation in SLE.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Subclinical Corneal Nerve Fiber Damage and Immune Cell Activation in Systemic Lupus Erythematosus: A Corneal Confocal Microscopy Study

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Ergun

et al. 2021

Trans. Vis. Sci. Tech.

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“…The pathogenesis of LE is largely unknown. Small fiber damage and decreased IENF density (IENFD) were found in patients with SLE [ 25 ]. Neuropathic itch as an initial presentation in a patient with lupus transverse myelitis has been reported [ 26 ].…”

Section: Cutaneous Lupus Erythematosus (Cle)mentioning

confidence: 99%

“…IL-6 was related to the pruritus transduction in prurigo nodularis [ 27 ] and calcium phosphate-induced pruritus [ 28 ]. Increased expression of IL-6 in the skin of patients with SLE was found [ 25 ]. On the other hand, IL-6 can activate IL4+ CD4+ T cells [ 29 ], which may indirectly activate downstream itch pathways.…”

Section: Cutaneous Lupus Erythematosus (Cle)mentioning

confidence: 99%

Autoimmune Connective Tissue Diseases-Related Pruritus: Proper Diagnosis and Possible Mechanisms

Wong

Yen

2022

Diagnostics

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Pruritus is a well-known bothersome symptom among skin disorders, especially inflammatory skin disorders. Lately, a high prevalence of pruritus in patients with autoimmune connective tissue diseases (ACTDs) has been revealed. Patients with ACTDs may suffer from varying degrees of pruritus, which affect their quality of life. However, it is rarely recognized both by patients and physicians. Meanwhile, pruritus is not only a symptom but is also related to the disease severity of some ACTDs. The pathophysiology of ACTD related pruritus is ambiguous. This review summarizes the features and possible mechanisms of ACTD-related pruritus, which might lead to proper diagnosis and treatment.

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“…On the contrary, SFN with a decrease in intraepidermal nerve fiber density (IENFD) was shown in prurigo nodularis, which has featured such as intractably itchy hyperkeratotic nodules [ 8 ]. SFN is characterized in patients with systemic LE (SLE) even in non-lesional skin [ 9 ]. Nevertheless, there is limited study about the cutaneous nerve fiber density in DM.…”

Section: Introductionmentioning

confidence: 99%

Increased Epidermal Nerve Growth Factor without Small-Fiber Neuropathy in Dermatomyositis

Wong

Lee

Yen

2022

IJMS

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Small-fiber neuropathy (SFN) is suggested to be involved in the pathogenesis of some types of autoimmune connective tissue diseases. SFN with a reduction in epidermal nerve fibers might affect sensory fibers and cause neuropathic symptoms, such as pruritus and pain, which are common in both dermatomyositis (DM) and cutaneous lupus erythematosus (CLE). Nerve growth factor (NGF) has been recognized as important in nociception by regulating epidermal nerve fiber density and sensitizing the peripheral nervous system. The present study aimed to investigate whether SFN was associated with the cutaneous manifestations of DM and CLE. We also investigated the relationship between SFN and axon guidance molecules, such as NGF, amphiregulin (AREG), and semaphorin (Sema3A) in DM and CLE. To explore the molecular signaling, interleukin (IL)-18 and IL-31, which have been implicated in the cutaneous manifestation and neuropathic symptoms in DM, were examined in keratinocytes. Our results revealed that intraepidermal nerve fiber density (IENFD) was unchanged in patients with DM, but significantly reduced in IENFD in patients with CLE compared with healthy control. Increased epidermal expression of NGF and decreased expression of Sema3A were demonstrated in patients with DM. Furthermore, IL-18 and IL-31 both induced the production of NGF from keratinocytes. Taken together, IL-18 and IL-31 mediated epidermal NGF expression might contribute to the cutaneous neuropathic symptoms in DM, while SFN might be important for CLE.

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Small fiber neuropathy and related factors in patients with systemic lupus erythematosus; the results of cutaneous silent period and skin biopsy

Cited by 11 publications

References 37 publications

Subclinical Corneal Nerve Fiber Damage and Immune Cell Activation in Systemic Lupus Erythematosus: A Corneal Confocal Microscopy Study

Subclinical Corneal Nerve Fiber Damage and Immune Cell Activation in Systemic Lupus Erythematosus: A Corneal Confocal Microscopy Study

Autoimmune Connective Tissue Diseases-Related Pruritus: Proper Diagnosis and Possible Mechanisms

Increased Epidermal Nerve Growth Factor without Small-Fiber Neuropathy in Dermatomyositis

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