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Lasse G. Gøransson, MD; Anne B. Tjensvoll, MD; Anita Herigstad, MD; Svein I. Mellgren, MD, PhD; Roald Omdal, MD, PhD

Arch Neurol. 2006;63:401-404.

Background  Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune, multiorgan disease often involving the central and peripheral nervous systems.

Objective  To determine whether there is a selective small-diameter nerve fiber neuropathy in patients with SLE.

Design  Cross-sectional study.

Setting  Stavanger University Hospital, Stavanger, Norway.

Patients  Sixty patients with SLE, aged 43.2 ± 13.5 years (mean ± SD).

Interventions  Skin biopsies, nerve conduction studies, and clinical neurologic examinations.

Main Outcome Measures  Density of intraepidermal small-diameter nerve fibers in skin biopsy specimens and large-diameter nerve fiber function as determined by nerve conduction studies and clinical examinations.

Results  The mean density of intraepidermal small-diameter nerve fibers in patients with SLE was 7.5 ± 3.8/mm. Eight patients (13%) had densities below reference values, consistent with small-diameter nerve fiber neuropathy, and results of nerve conduction studies were normal in 6 of them. Eleven patients (18%) had abnormal results of nerve conduction studies, reflecting large-diameter nerve fiber neuropathy, and 4 patients (7%) were classified by an experienced neurologist as having polyneuropathy after the clinical examination.

Conclusions  An abnormal reduction in intraepidermal small-diameter nerve fiber densities is evident in some patients despite normal function of their larger nerve fibers. This adds further support to the theory that a pure small-diameter nerve fiber neuropathy may occur in SLE.

Author Affiliations: Departments of Internal Medicine (Drs Gøransson and Omdal), Neurology (Dr Tjensvoll), and Clinical Neurophysiology (Dr Herigstad), Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway (Drs Gøransson and Omdal); and Institute of Clinical Medicine, University of Tromsø (Dr Mellgren), and Department of Neurology, University Hospital of North Norway (Dr Mellgren), Tromsø.

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