Systemic lupus erythematosus may have an early effect on peripheral nerve function in patients without clinical or electrophysiological neuropathy: comparison with age- and gender-matched controls

Abstract

Asymptomatic electrophysiological peripheral neuropathy is described in systemic lupus erythematosus (SLE) patients. To determine if SLE could have an even earlier effect on peripheral nerve function even before the development of electrophysiological abnormalities, we compared nerve conduction studies (NCS) of SLE patients without electrophysiological or clinical peripheral neuropathy with healthy controls. Consecutive SLE patients without clinical neuropathy (or other known causes of neuropathy) underwent sensory and motor NCS of all four limbs. Results of 61 patients without electrophysiological criteria of neuropathy were compared with age- and gender-matched controls. Although still within the laboratory’s range of normal values, significant differences were found in several NCS parameters between patients and controls. SLE patients had lower amplitudes for ulnar, fibular, and tibial compound muscle action potentials (CMAP) and sural sensory nerve action potentials (SNAP); slower conduction velocities for median, ulnar, and fibular motor nerves, and median, ulnar and sural sensory nerves. SLE patients also had longer minimum F-wave latencies for median, ulnar, fibular, and tibial nerves. H reflexes were more often absent in patients. Correlations were found between the number of disease relapses and motor conduction velocities of the fibular and tibial nerves. SLE may have early effect on peripheral nerve function in patients even before they develop electrophysiological or clinical neuropathy.

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References

  1. 1.

    American College of Rheumatology (1999) The American college of rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608

    Article  Google Scholar 

  2. 2.

    Bortoluzzi A, Silvagni E, Furini F, Piga M, Govoni M (2019) Peripheral nervous system involvement in systemic lupus erythematosus: a review of the evidence. Clin Exp Rheumatol 37:146–155

    PubMed  Google Scholar 

  3. 3.

    Toledano P, Orueta R, Rodríguez-Pintó I, Valls-Solé J, Cervera R, Espinosa G (2017) Peripheral nervous system involvement in systemic lupus erythematosus: prevalence, clinical and immunological characteristics, treatment and outcome of a large cohort from a single centre. Autoimmun Rev 16:750–755

    CAS  Article  Google Scholar 

  4. 4.

    Florica B, Aghdassi E, Su J, Gladman DD, Urowitz MB, Fortin PR (2011) Peripheral neuropathy in patients with systemic lupus erythematosus. Semin Arthritis Rheum 41:203–211

    Article  Google Scholar 

  5. 5.

    Oomatia A, Fang H, Petri M, Birnbaum J (2014) Peripheral neuropathies in systemic lupus erythematosus: clinical features, disease associations, and immunologic characteristics evaluated over a twenty-five–year study period. Arthritis Rheumatol 66:1000–1009

    CAS  Article  Google Scholar 

  6. 6.

    Jasmin R, Sockalingam S, Ramanaidu L, Goh K (2015) Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients. Lupus 24:248–255

    CAS  Article  Google Scholar 

  7. 7.

    Xianbin W, Mingyu W, Dong X et al (2015) Peripheral neuropathies due to systemic lupus erythematosus in China. Medicine 94(e625):8

    Google Scholar 

  8. 8.

    Saigal R, Bhargav R, Goyal L, Agrawal A, Mital P, Wadhwani D (2015) Peripheral neuropathy in systemic lupus erythematosus: clinical and electrophysiological properties and their association with disease activity parameters. J Assoc Physicians India 63:15–19

    PubMed  Google Scholar 

  9. 9.

    Brey RL, Holliday SL, Saklad AR et al (2002) Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 58:1214–1220

    CAS  Article  Google Scholar 

  10. 10.

    Mok CC, To CH, Mak A (2006) Neuropsychiatric damage in Southern Chinese patients with systemic lupus erythematosus. Medicine 85:221–228

    Article  Google Scholar 

  11. 11.

    Huynh C, Ho SL, Fong KY, Cheung RT, Mok CC, Lau CS (1999) Peripheral neuropathy in systemic lupus erythematosus. J Clin Neurophysiol 16:164–168

    CAS  Article  Google Scholar 

  12. 12.

    Omdal R, Henriksen OA, Mellgren SI, Husby G (1991) Peripheral neuropathy in systemic lupus erythematosus. Neurology 41:808–811

    CAS  Article  Google Scholar 

  13. 13.

    Sivri A, Hascelik Z, Celiker R, Basgoze O (1995) Early detection of neurological involvement in systemic lupus erythematosus patients. Electromyogr Clin Neurophysiol 35:195–199

    CAS  PubMed  Google Scholar 

  14. 14.

    Goh K, Wang C, Leong S, Tan C (1996) Peripheral neuropathy in systemic lupus erythematosus: electrophysiological features in 50 consecutive cases. Neurol J Southeast Asia 1:47–51

    Google Scholar 

  15. 15.

    Omdal R, Loseth S, Torbergsen T, Koldingsnes W, Husby G, Mellgren SI (2001) Peripheral neuropathy in systemic lupus erythematosus—a longitudinal study. Acta Neurol Scand 103:386–391

    CAS  Article  Google Scholar 

  16. 16.

    Petri M, Orbai AM, Alarcón GS et al (2012) Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64:2677–2686

    Article  Google Scholar 

  17. 17.

    Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The committee on prognosis studies in SLE. Arthritis Rheum 35:630–640

    CAS  Article  Google Scholar 

  18. 18.

    Fong SY, Goh KJ, Shahrizaila N, Wong KT, Tan CT (2016) Effects of demographic and physical factors on nerve conduction study values of healthy subjects in a multi-ethnic Asian population. Muscle Nerve 54:244–248

    Article  Google Scholar 

  19. 19.

    England JD, Gronseth GS, Franklin G et al (2005) Distal symmetric polyneuropathy: a definition for clinical research: report of the american academy of neurology, the American association of electrodiagnostic medicine, and the American academy of physical medicine and rehabilitation. Neurology 64:199–207

    CAS  Article  Google Scholar 

  20. 20.

    Mikdashi J, Handwerger B (2004) Predictors of neuropsychiatric damage in systemic lupus erythematosus: data from the Maryland lupus cohort. Rheumatology 43:1555–1560

    CAS  Article  Google Scholar 

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Funding

This work was supported by University of Malaya research grant (RG282/11 HTM).

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All authors contributed to the study conception, design, and material preparation. Data collection and analysis were performed by SYF and KJG. The first draft of the manuscript was written by SYF and KJG. Others revised it critically for important intellectual content. All authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript and version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Khean-Jin Goh.

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Conflict of interest

All authors (Sue Yng FONG, Jasmin RAJA, Kum Thong WONG, and Khean Jin GOH) declare no conflict of interest.

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This study is in compliance with ethical standards. This study which involved human participants was approved by the University of Malaya Medical Centre (UMMC) Medical Ethics Committee (Ref No. 806.12). The authors certify that the study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Fong, SY., Raja, J., Wong, KT. et al. Systemic lupus erythematosus may have an early effect on peripheral nerve function in patients without clinical or electrophysiological neuropathy: comparison with age- and gender-matched controls. Rheumatol Int 41, 355–360 (2021). https://doi.org/10.1007/s00296-020-04610-8

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Keywords

  • Systemic lupus erythematosus
  • Nerve conduction studies
  • Early effect
  • Peripheral nerve function