Improvement of Nerve Fiber Density in Fibromyalgia Patients Treated with IVIg

Abstract

: Small fiber neuropathy and fibromyalgia are two conditions that share overlapping features. Although various treatments are available for use in fibromyalgia, the response often remains unsatisfactory. Prior studies have shown that in small fiber neuropathy of autoimmune etiology, intravenous immunoglobulin (IVIg) holds promise as an effective treatment. Herein we report the use of IVIg in 7 patients who have both fibromyalgia and small fiber neuropathy. Skin punch biopsy evaluating the nerve fiber density was performed prior to diagnosis and after 6 months of IVIg therapy in each individual. Patient’s symptoms were obtained via a fibromyalgia questionnaire pre- and post- treatment. At the end of 6 months therapy, overall patients reported less fibromyalgia symptoms and skin biopsy demonstrated improvements as well. This retrospective pilot study suggests IVIg is a viable potential therapy in a subset of fibromyalgia patients who have small fiber neuropathy.

Neuroimmunology: What Role for Autoimmunity, Neuroinflammation, and Small Fiber Neuropathy in Fibromyalgia, Chronic Fatigue Syndrome, and Adverse Events after Human Papillomavirus Vaccination?

“…Their deficit in IENFD can promote inflammation. Another proof of the autoimmune nature of SFN in FM comes from the results of treatment: Intravenous polyclonal immunoglobulin has been proven to be very effective for improving SFN in patients with FM [65]. There are two hypotheses on the relationship between SFN, the immune system, and central sensitization in FM.…”

The challenge of differentiating fibromyalgia from small-fiber neuropathy in clinical practice

“…Antidepressants (nortriptyline, amitriptyline, duloxetine, milnacipran, venlafaxine), anticonvulsants (gabapentin, pregabalin, lamotrigine, oxcarbazepine, carbamazepine, sodium valproate, lacosamide, topiramate), mexiletine, topical agents (capsaicin, lidocaine), opioids are frequently suggested, given their modest efficacy in large fibre neuropathy. Intravenous immunoglobulin (IVIG) was reported to reduce pain and paraesthesia in immune-mediated diseases SFN, especially in Sjogren's syndrome, systemic lupus erythematosus and sarcoidosis-associated smallfibre neuropathy [56]. Potentially treatable causes could be identifiable in one-third to one-half of patients with SFN [57].…”

La fibromialgia: posible enfermedad autoinmune

“…Estos hallazgos evidencian mecanismos de autoinmunidad mediada por autoanticuerpos, con especificidad todavía no determinada, pero en gran medida dirigida contra proteínas neuronales. En este sentido cobra protagonismo la controvertida presencia de neuropatía de fibra fina presente en pacientes con FM, y su mejoría histológica y clínica tras tratamiento con Igls, aunque esto pueda ser solo un epifenómeno (6). Otro dato a favor de la autoinmunidad es la asociación con otras enfermedades autoinmunes, con un prevalencia aumentada que representa en 20 % en los pacientes con artritis reumatoide, el 30 % en el lupus eritematoso sistémico, el 50 % en el síndrome de Sjögren y el 13-18 % en las espondiloartritis (7).…”