Small fiber neuropathy in women with fibromyalgia. An in vivo assessment using corneal confocal bio-microscopy

Ramı́rez, Manuel; Martínez-Martínez, Laura-Aline; Hernández-Quíntela, Everardo; Velazco-Casapía, Jorge; Vargas, Angélica; Martı́nez-Lavı́n, Manuel

doi:10.1016/j.semarthrit.2015.03.003

Cited by 92 publications

(81 citation statements)

References 27 publications

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“…Lower CNFD and CNFL counts were reported in small cohorts of patients with FMS when investigated with CCM compared to healthy controls . Also, reduced nerve fiber branching and thinning of corneal stromal nerve fibers was found in FMS patients compared to healthy controls . We reproduced these findings for CNFD and CNFL, though did not observe a difference in nerve branching (CNBD) between FMS patients and healthy controls.…”

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 80%

“…In recent studies, small nerve fiber pathology was found in subgroups of patients with fibromyalgia syndrome (FMS) . Applying corneal confocal microscopy (CCM), corneal denervation was also reported in FMS patients …”

Section: Introductionmentioning

confidence: 99%

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Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome

Klitsch

Evdokimov

Frank

et al. 2020

J Peripheral Nervous Sys

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In our study, we aimed at investigating corneal langerhans cells (LC) in patients with fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) as potential contributors to corneal small fiber pathology. We enrolled women with FMS (n = 134) and SFN (n = 41) who underwent neurological examination, neurophysiology, prostaglandin analysis in tear fluid, and corneal confocal microscopy (CCM). Data were compared with those of 60 age‐matched female controls. After screening for dry eye disease, corneal LC were counted and sub‐classified as dendritic (dLC) and non‐dendritic (ndLC) cells with or without nerve fiber association. We further analyzed corneal nerve fiber density (CNFD), length (CNFL), and branch density (CNBD). Neurological examination indicated deficits of small fiber function in patients with SFN. Nerve conduction studies were normal in all participants. Dry eye disease was more prevalent in FMS (17%) and SFN (28%) patients than in controls (5%). Tear fluid prostaglandin levels did not differ between FMS patients and controls. While corneal LC density in FMS and SFN patients was not different from controls, there were fewer dLC in association with nerve fibers in FMS and SFN patients than in controls (P < .01 each). Compared to controls, CNFL was lower in FMS and SFN patients (P < .05 each), CNFD was lower only in FMS patients (P < .05), and CNBD was lower only in SFN patients (P < .001). There was no difference in any CCM parameter between patients with and without dry eyes. Our data indicate changes in corneal innervation and LC distribution in FMS and SFN, potentially based on altered LC signaling.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 80%

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Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome

Klitsch

Evdokimov

Frank

et al. 2020

J Peripheral Nervous Sys

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“…And among 41 patients with unexplained chronic widespread pain starting in childhood (i.e., juvenile fibromyalgia), 30% of skin biopsies, 53% of AFT and 2/2 nerve biopsies were diagnostic for SFPN [43]. Multiple groups have now reported that almost half of patients with fibromyalgia have objective evidence of underlying SFPN [2, 15, 23, 34, 42, 53, 58, 68]. Given that fibromyalgia affects 2–5% of the world’s population [71], idiopathic SFPN may be far more common than appreciated, so cost-effective screening strategies are needed.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy

2016

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Small-fiber polyneuropathy (SFPN) causes non-specific symptoms including chronic pain, cardiovascular, gastrointestinal, and sweating complaints. Diagnosis is made from history and exam in patients with known risk factors such as diabetes, but objective test confirmation is recommended for patients without known risks. If tests confirm SFPN, and it is “initially idiopathic” (iiSFPN), screening for occult causes is standard. This study’s aim was to evaluate the 21 widely available, recommended blood tests to identify the most cost-effective ones and to learn about occult causes of iiSFPN. Records were reviewed from all 213 patients with SFPN confirmed by distal-leg skin biopsy, nerve biopsy, or autonomic-function testing in our regional center during 2013. We determined the prevalence of each abnormal blood-test result (ABTR) in the iiSFPN cohort, compared this to population averages, and measured the costs of screening subjects to obtain one ABTR. Participants were 70% female and 43.0±18.6 years old. High erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA; ≥1:160 titer) were each present in 28% of subjects. The ABTR ≥ 3× more prevalent in iiSFPN than in the total population were high ESR, high ANA, low C3, Sjögren’s and celiac autoantibodies. Together, these suggest the possibility of a specific association between iiSFPN and dysimmunity. ATR identifying diabetes, prediabetes, and hypertriglyceridemia were less common in iiSFPN than in the population and thus not associated with iiSFPN here. Reimbursement for the 6 most cost-effective iiSFPN-associated blood tests–ESR, ANA, C3, autoantibodies for Sjögren’s and celiac, plus thyroid-stimulating hormone–was $99.57/person with 45.6% sensitivity for detecting one abnormal result. Angiotensin-converting enzyme was elevated in 45% but no patients had sarcoidosis, so this test was futile here.

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“…Certains auteurs avancent plus récemment l'idée que des neuropathies à petites fibres pourraient aussi jouer un rôle au cours de la fibromyalgie, au niveau périphérique [26].…”

Section: Comment éValuer La Fibromyalgie ?unclassified

Fibromyalgia: Where are we in 2015?

Laroche

Guérin

2015

Douleur analg

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Small fiber neuropathy in women with fibromyalgia. An in vivo assessment using corneal confocal bio-microscopy

Cited by 92 publications

References 27 publications

Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome

Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome

Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy

Fibromyalgia: Where are we in 2015?

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