Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study

Abstract

ObjectiveTo evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy.MethodsThis is an observational cross-sectional study on patients with SLE and healthy controls. Five nerves in each patient were examined bilaterally with NMUS, and the cross-sectional area (CSA) of each nerve at certain sites was estimated. The mean CSA at each site, for each nerve, in each group was statistically analysed and compared between groups.Results370 nerves were evaluated in 37 patients. By nerve conduction study (NCS), 36 patients had polyneuropathy (80.6% mixed type, 19.4% sensory). Significant mean CSA enlargement was present among the ulnar nerve at the Guyon’s canal and mid-humerus (both p=0.001); tibial nerve at the distal leg and proximal to the tarsal tunnel (p=0.003 and p=0.001, respectively); and peroneal nerve at the popliteal fossa (p=0.042). The mean CSA showed high specificity compared with NCS.ConclusionOur study shows that CSA could be a complementary tool to NCS for studying peripheral neuropathy in SLE. Furthermore, NMUS provides data on the different pathophysiological aspects of nerve involvement in SLE. Future studies using more than one sonographic parameter in combination with NCS and nerve histopathology are recommended to further investigate SLE-related neuropathy.Trial registration numberNCT04527172.

Sonographic peripheral nerve cross‐sectional area in adults, excluding median and ulnar nerves: A systematic review and meta‐analysis

“…Although this review is not intended to diagnose any peripheral nerve diseases, ultrasound is emerging as a reliable adjunct or alternative to nerve conduction studies for diagnosing select mononeuropathies 4,68,97,98 and a variety of peripheral neuropathies. [99][100][101] As such, detailed sonographic peripheral nerve anatomy will continue to facilitate the use of neuromuscular ultrasound as a diagnostic tool. The present study builds upon previous work that compiled mean nerve CSAs for a selection of peripheral nerves.…”

“…The results of this review highlight the population variability in adult peripheral nerve anatomy. Although this review is not intended to diagnose any peripheral nerve diseases, ultrasound is emerging as a reliable adjunct or alternative to nerve conduction studies for diagnosing select mononeuropathies 4,68,97,98 and a variety of peripheral neuropathies 99–101 . As such, detailed sonographic peripheral nerve anatomy will continue to facilitate the use of neuromuscular ultrasound as a diagnostic tool.…”

High-resolution ultrasound of peripheral neuropathies in rheumatological patients: An overview of clinical applications and imaging findings

“…The relation between PN occurrence and SLE disease activity or systemic involvement is not univocal: in some studies the symptomatic polyneuropathy was independently associated only with age while other case series have found associations with age onset and SLE disease activity scores ( 51 , 59 ). Regarding nerve imaging, only one study has investigated the morphological features of PN related to SLE ( 60 ): in a cohort of 37 patients, the mean CSA of the ulnar nerve at the Guyon’s canal and mid-humerus, of the tibial nerve at the distal leg and proximal to the tarsal tunnel and of the peroneal nerve at the popliteal fossa resulted significantly increased in respect to gender and age-matched healthy control group. As already reported, HRUS is less informative in axonal neuropathies since the findings are less remarkable.…”

The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic

“… 36 Using combined US parameters in association with nerve conduction studies (NCS) and nerve histopathology are highly suggested to further look into systemic lupus erythematosus (SLE) neuropathy. 37 …”