SLE-related polyneuropathy is a chronic, axonal and predominantly sensory neuropathy, associated with older age. Its underlying pathogenetic mechanisms are unknown, although a possibility could be an increased susceptibility of peripheral nerves in SLE patients to effects of aging.

Aim The reported prevalence of peripheral neuropathy in systemic sclerosis (SSc) is variable between 0.01% to 28%, probably due to differences in sample size, study design and population. Our aim is to determine the prevalence of large fiber peripheral neuropathy in SSc and to identify any contributing factors. Method A prospective cross‐sectional study of 60 SSc patients were evaluated for large fiber neuropathy using the modified clinical Total Neuropathy Score (cTNS) and nerve conduction study (NCS) of the upper and lower limbs. A combination of clinical (cTNS score ≥ 2) and NCS criteria (≥2 abnormal nerves including 1 sural [symmetrical polyneuropathy] and NCS abnormalities consistent with individual nerves/nerve roots [focal neuropathy]) was used to diagnose peripheral neuropathy. Results The majority had limited cutaneous subset (75%). Mean age was 55.73 (SD ± 13.04) years and mean disease duration was 8.61 (SD ± 8.09) years. Twenty‐two (36.7%) had combined clinical and NCS criteria for peripheral neuropathy, 14 (23.3%) with symmetrical polyneuropathy and 8 (13.3%) with focal neuropathy. Symmetrical polyneuropathy patients had significantly lower hemoglobin levels (11.2 vs. 12.35 g/L; P = .047). Serum vitamin B12 levels were normal, therefore excluding vitamin B12 deficiency. No other associations were found for both polyneuropathy and focal neuropathy with demography, co‐morbid diseases and SSc disease factors such as Raynaud's phenomenon and modified Rodnan skin score. Conclusion Large fiber neuropathy is common in SSc patients, which could contribute to non‐lethal burden in SSc with sensory loss and muscle weakness. Apart from lower hemoglobin in polyneuropathy, there were no associations with disease‐specific features or co‐morbid diseases.

BackgroundPeripheral neuropathy (PN) in systemic sclerosis (SSc) is an under recognised non-lethal burden with its prevalence between 0.01% to 28%1. Previous studies have been limited by small sample size, variable diagnostic criteria and different populations studied.ObjectivesThe aim of this study is to determine the prevalence of symmetrical PN in SSc patients and to identify the associated factors that can predispose to PN in SSc.Methods59 SSc patients from University Malaya Medical Centre participated in this cross-sectional study. Clinical symptoms/signs of PN were assessed using modified Total Neuropathy Score (TNS). Nerve conduction studies (NCS) were carried out on the upper and lower limbs. Diagnosis of symmetrical polyneuropathy was defined as combined TNS score ≥2 and abnormal NCS parameters in at least 2 nerves including the sural2. Focal neuropathy was defined as abnormal NCS of a nerve other than the sural nerve (radial, median, ulnar, common peroneal).ResultsMajority were females (54, 91.5%) and had limited cutaneous SSc (44,74.6%). Mean age was 55.7 (SD ±13.1) years while mean duration of disease (non-Raynaud’s disease onset) was 8.74 years (SD ±8.09) (range 1 to 44 years). Out of 59 patients, 38 (64.4%) had TNS≥2. On NCS, 17 (31.5%) and 12 (22.2%) had findings of symmetrical polyneuropathy and focal neuropathy respectively. A total of 14 (23.7%) SSc patients were diagnosed to have symmetrical polyneuropathy. Lower haemoglobin level was significantly associated with symmetrical polyneuropathy (p=0.047) after adjustment for potential confounding variables. Serum vitamin B12 was normal in all subjects with symmetrical polyneuropathy. No correlation was seen in SSc related comorbidities (diabetes mellitus and kidney disease), serum fasting blood sugar, creatinine and MCV, as well as disease markers such as skin fibrosis (MRSS skin score), specific organ manifestations, Raynaud’s or vasculopathy, SSc specific auto-antibodies and treatment received. DemographyNo polyneuropathy n=45 (76.3%)Polyneuropathy n=14 (23.7%)p value Mean age (y.o±)53.6±13.2262.57±10.690.025 Sexn (%)Female45 (76.3)14 (23.7)0.325 Male5 (100)0 (0) BMI kg/m2 (mean)22.9±5.9421.0±5.130.736 Diffuse SSc10 (22.2)4 (28.5)0.722 Limited SSc35 (77.7)10 (71.4)0.316 MRSS score (mean)10.29±8.028.36±4.230.594SSc duration (mean)8.97±8.788.00±5.510.803Haemoglobin (mean) (g/L)12.36±1.3311.2±1.250.010MCV>97 (fl)4 (8.9)3 (21.4)0.175Creatinine (median) (umol/L)55±(IQR 45–60)61.5±(IQR 49–75)0.111Fasting blood sugar (mean) (mmol/L)4.32±1.165.67±2.460.095ESR (mean) (mm/hr)33.7±20.6544.23 (19.6)0.068ConclusionsThe prevalence of PN in a Malaysian SSc cohort is similar to other studies (23.7%). Lower haemoglobin level was significantly associated with symmetrical polyneuropathy in SSc.References[1] Paik JJ, et al. Symptomatic and Electrodiagnostic Features of Peripheral Neuropathy in Scleroderma. Arthritis Care Res (Hoboken)2016;6(8):1150–57.[2] England JD, et al. Distal symmetrical polyneuropathy: a definition for clinical research. A report of the America...