Division of Rheumatology, Department of Internal Medicine, University of Utah, 4B200 SOM 30 N 1900 E, Salt Lake City, UT 84132, USA.
Clin Rheumatol. 2013 Jun;32(6):885-8. doi: 10.1007/s10067-013-2206-6. Epub 2013 Feb 13.
We performed bedside testing for peripheral neuropathy in our systemic sclerosis (SSc) population to determine whether foot care guidelines should be developed for SSc. Twenty consecutive SSc patients and 20 healthy control (HC) patients were evaluated for peripheral neuropathy in both feet using the 10-g Semmes-Weinstein monofilament examination (SWME) and 128 Hz vibration sensation using the on-off method. Independent, blinded, vibratory sensation, and SWME evaluations were performed on each subject by two investigators who had completed a training session to standardize each exam. An additional consecutive 20 patients with type 2 diabetes mellitus (DM) were examined by a diabetologist to compare with peripheral neuropathy prevalence in SSc patients. We examined the inter-rater variability using Cohen's kappa. We compared SWME and vibratory sensation in SSc to HC using Fisher's exact. The t test was used to compare duration of disease and modified Rodnan skin score (mRSS) for those with abnormal SWME or vibratory sensation. Two of 20 SSc patients reported sensory foot symptoms consistent with peripheral neuropathy prior to the examination. Inter-rater agreement for both SWME and vibratory sensation was strong (kappa: 0.72 and 0.83, respectively). Two HC and 12 SSc patients demonstrated abnormal vibratory sense (one-sided Fishers' exact, p < 0.002). No HC and four SSc patients had abnormal monofilament exams (one-sided Fisher's exact, p = 0.053). Neither mRSS (p = 0.28) nor duration of non-Raynauds (p = 0.07) symptoms differed between those with peripheral neuropathy and those without. Duration of Raynaud's symptoms were clinically significantly associated with presence of peripheral neuropathy (p = 0.04). The prevalence of sensory loss to monofilament in SSc was identical to DM patients (4/20). SSc patients have a considerable prevalence of pedal peripheral neuropathy as detected by loss of vibratory sensation or inability to sense the 10-g SWME. Further studies are indicated to determine if routine screening for neuropathy and subsequent podiatric care for SSc patients with abnormalities can reduce pedal complications.
我们对系统性硬化症（SSc）患者进行了周围神经病变的床边检测，以确定是否应该制定 SSc 的足部护理指南。使用 10g Semmes-Weinstein 单丝检查（SWME）和 128Hz 振动感觉的开-关法，对 20 例连续的 SSc 患者和 20 例健康对照（HC）患者的双脚进行周围神经病变检测。两名经过培训以标准化每项检查的独立、盲法、振动感觉和 SWME 评估员对每位受试者进行了评估。另外，还由一名糖尿病专家对 20 例 2 型糖尿病（DM）患者进行了检查，以比较 SSc 患者周围神经病变的患病率。我们使用 Cohen's kappa 检验评估了评分者间的变异性。我们使用 Fisher 确切检验比较了 SSc 患者的 SWME 和振动感觉与 HC。对于 SWME 或振动感觉异常的患者，使用 t 检验比较疾病持续时间和改良 Rodnan 皮肤评分（mRSS）。20 例 SSc 患者中有 2 例在检查前报告了与周围神经病变一致的足部感觉症状。SWME 和振动感觉的评分者间一致性均很强（kappa：0.72 和 0.83）。2 例 HC 和 12 例 SSc 患者的振动感觉异常（单侧 Fisher 确切检验，p<0.002）。没有 HC 和 4 例 SSc 患者的单丝检查异常（单侧 Fisher 确切检验，p=0.053）。周围神经病变患者和无周围神经病变患者之间的 mRSS（p=0.28）和非雷诺氏症状持续时间（p=0.07）均无差异。周围神经病变与雷诺氏症状的持续时间具有显著的临床相关性（p=0.04）。SSc 患者的单丝感觉丧失的患病率与 DM 患者相同（4/20）。通过振动感觉丧失或无法感知 10g SWME 检测到，SSc 患者存在相当大的足部周围神经病变患病率。需要进一步的研究来确定是否可以对 SSc 患者进行常规神经病变筛查和随后的足部护理，以减少足部并发症。
