疼痛性小纤维神经病的临床特征提示原发性干燥综合征相关的起源。
The Clinical Features of Painful Small-Fiber Neuropathy Suggesting an Origin Linked to Primary Sjögren's Syndrome.
机构信息
EA 4391, Faculty of Medicine, Paris-Est-Creteil University, Créteil, France.
Physiological Investigations, Habib Bourguiba University Hospital, Sfax, Tunisia.
出版信息
Pain Pract. 2019 Apr;19(4):426-434. doi: 10.1111/papr.12763. Epub 2019 Feb 6.
OBJECTIVE
We attempted to determine whether clinical features could differentiate painful small-fiber neuropathy related to primary Sj€ogren's syndrome (pSS-SFN) from idiopathic SFN (idio-SFN).
METHODS
Validated clinical questionnaires and neurophysiological investigations specific for pain and SFN assessment were performed in 25 patients with pSS-SFN and 25 patients with idio-SFN.
RESULTS
Patients with idio-SFN had more frequent severe burning sensations and higher mean anxiety scores and daily pain intensity compared to patients with pSSSFN. Conversely, patients with pSS-SFN had reduced electrochemical skin conductance measured by Sudoscan_, and almost half of them had the sensation of walking on cotton wool.
CONCLUSION
Our results suggest that idio-SFN more specifically involved small sensory fibers than pSS-SFN, in which subtle dysfunction of larger sensory fibers and damage of distal autonomic sudomotor innervation may occur. A practical algorithm is proposed to help to differentiate SFN associated with pSS from idio-SFN, based on information very easy to obtain by clinical interview.
目的
我们试图确定临床特征是否可以区分与原发性干燥综合征（pSS-SFN）相关的痛性小纤维神经病与特发性小纤维神经病（idio-SFN）。
方法
对 25 例 pSS-SFN 患者和 25 例 idio-SFN 患者进行了经过验证的用于疼痛和 SFN 评估的临床问卷和神经生理学检查。
结果
与 pSS-SFN 患者相比，idio-SFN 患者更频繁地出现严重烧灼感，焦虑评分和日常疼痛强度的平均值更高。相反，pSS-SFN 患者的 Sudoscan_ 测量的电化学皮肤传导率降低，几乎一半的患者有走在棉花上的感觉。
结论
我们的结果表明，idio-SFN 比 pSS-SFN 更具体地涉及小感觉纤维，其中较大的感觉纤维的细微功能障碍和远端自主运动神经支配的损害可能发生。根据临床访谈中非常容易获得的信息，提出了一种实用的算法来帮助区分与 pSS 相关的 SFN 与 idio-SFN。
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