Small nerve fiber involvement in systemic lupus erythematosus: A controlled study

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Abstract
Objective: To determine if patients with systemic lupus erythematosus (SLE) may have a peripheral neuropathy involving unmyelinated and small, myelinated nerve fibers, by immunostaining epidermal nerve fibers (ENF) in skin biopsy samples for the panaxonal marker, protein gene product 9.5 (PGP 9.5).Methods: Fifteen consecutive and nonselected SLE patients and 15 age‐ and sex‐matched controls were included in the study. The age of the patients ranged from 25 years to 65 years, with a mean ± SD age of 47.3 ± 10.2 years and a disease duration of 2–28 years (mean ± SD 14.8 ± 8.6 years). Two 3‐mm skin biopsy samples were obtained with a punch needle ∼10 cm superior to the lateral malleolus of the right leg and immunostained with 0.1% rabbit polyclonal antibodies to human PGP 9.5. The number of ENF per millimeter was counted and recorded as the mean ± SD of counts in six 50‐μm sections, 3 from each of the 2 biopsy samples.Results: The mean number of ENF per mm in patients with SLE was 8.0 ± 1.5 (range 5.0–9.9), while the matched controls had 12.2 ± 3.8 ENF per mm (range 6.8–18.6) (P = 0.0006).Conclusion: This study indicates that a small fiber involvement in patients with SLE may be responsible for the prevalent neuropathic symptoms and impaired warm sense that is observed in such patients.
Funding Information
  • Norwegian Research Council for Science and the Humanities
  • Norwegian Foundation for Health and Rehabilitation