SAT0494 Clinical and electrophysiological diagnosis of symmetrical polyneuropathy in systemic sclerosis: study from a single tertiary centre in malaysia

Abstract

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...