Extreme efficacy of intravenous immunoglobulin therapy for severe burning pain in a patient with small fiber neuropathy associated with primary Sjögren’s syndrome

Wakasugi, Daisuke; Kato, Takashi; Gono, Takahisa; Ito, Eiichi; Nodera, Hiroyuki; Kawaguchi, Yasushi; Yamanaka, Hisashi; Hara, Masako

doi:10.3109/s10165-009-0180-2

Cited by 49 publications

(4 citation statements)

References 8 publications

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“…Most of the selected articles for the review were used skin biopsy for the definitive diagnosis and/or genetic tests [54,57] (Table 1). The skin biopsy was used alone [32,48,62] or in the most cases together with other diagnostic procedure, as nerve conduction examinations [33,41,56] or scales to assess the severity of the neuropathic symptoms (Table 1). Quantitative sensory testing (QST) with vibratory (VDT), cold (CDT), and heat-pain (HP) detection threshold testing were added for the specific diagnosis [30,40,61].…”

Section: Diagnostic Examinationmentioning

confidence: 99%

A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation

2020

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This systematic review describes the several methods to diagnose and measure the severity of small fiber neuropathies and aims to guide the physician to define all the diagnostic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Two reviewers independently reviewed and came to consensus on which articles met inclusion/exclusion criteria. The authors excluded all the duplicates, animals’ studies, and included the English articles in which the diagnostic measures were finalized to assess the effectiveness of rehabilitation and pharmacologic treatment of patients with small fiber neuropathies. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-one publications met the inclusion criteria and were included in the systematic review. Despite the range of diagnostic tools for the assessment of small fiber neuropathy, other robust trials are needed. In addition, always different diagnostic approaches are used, a unique protocol could be important for the clinicians. More research is needed to build evidence for the best diagnostic methodologies and to delineate a definitive diagnostic protocol.

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Section: Diagnostic Examinationmentioning

confidence: 99%

A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation

2020

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“…A small uncontrolled trial of intravenous immunoglobulins in Sjögren’s syndrome found a reduction in neuropathic pain in SFN,250 but in other series the response to corticosteroids has been poor 150251252. A small prospective, phase III clinical trial testing the benefit of intravenous immunoglobulins in patients with painful large fiber sensory polyneuropathy will soon be enrolling and could potentially inform treatment choices in patients with SFN that is associated with Sjögren’s syndrome (Clinical trials identifier NCT03700138).…”

Section: Emerging Disease Specific Treatmentsmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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“…Many different treatments were experienced. Opioid analgesics [8,21,24] or nonopioid analgesic [22,26], corticosteroids [8,10,33,34,37,44], intravenous immunoglobulin (IVIG) alone [8,12,15,23,27,31,37,39,46,47] or in combination with other specific drugs, such as azathioprine [29], anti-epileptic drugs [4,11,13,16,18,28,32], immunotherapy [14,19,37], hormone therapy [7,43]. Less used are the following therapeutic strategies, in used for specific disorders, such as ARA290, an erythropoietin derivate for sarcoidosis SFN [45], recombinant human nerve growth factor for diabetic SFN [5], propranolol for SFN related to aquagenic pruritus [9], plasma exchange therapy for complex regional pain syndrome [6], enzyme replacement therapy for Fabry related SFN [17,35], botulinum toxin type A for keloid [38].…”

Section: Pharmacologic and Rehabilitation Therapymentioning

confidence: 99%

“…The benefits of intravenous immunoglobulin (IVIG) were reported for neuropathic pain in Sjogren [8,27]. In 8 studies, the efficacy and safety of IVIg are evaluated in patients with different features of SFN [12,15,23,27,31,37,39,46,47]. In contrast, IVIG had disappointing results, according to Pereira et al [33] and Yuki et al [44].…”

Section: The Pharmacological Approachesmentioning

confidence: 99%

A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies

et al. 2020

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The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

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Extreme efficacy of intravenous immunoglobulin therapy for severe burning pain in a patient with small fiber neuropathy associated with primary Sjögren’s syndrome

Cited by 49 publications

References 8 publications

A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation

A Systematic Review of the Diagnostic Methods of Small Fiber Neuropathies in Rehabilitation

Diagnosis and management of sensory polyneuropathy

A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies

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