Current Pain and Headache Reports

, Volume 15, Issue 3, pp 201–206

Sarcoidosis and Small-fiber Neuropathy

Article

Abstract

Chronic pain is one of the most commonly reported symptoms among sarcoidosis patients. Not only does it significantly affect quality of life, but it also is a source of frustration for both the patient and physician because the etiology for pain often is unknown. Although patients typically complain of neuropathic-type pain, nerve conduction studies and other conventional diagnostic procedures frequently fail to reveal objective evidence of neurologic disease. However, in recent years, the growing use of specialized tests such as skin biopsy and sudomotor testing has helped to establish the diagnosis of small-fiber neuropathy as the cause of pain in these patients via objective and quantifiable means. Management of sarcoidosis small-fiber neuropathy should consist of target-directed treatment of the underlying disease and appropriate symptomatic therapy.

Keywords

Small-fiber neuropathy Pain Sarcoidosis Autoimmune 

References

Papers of particular interest, published recently, have been highlighted as • Of importance

  1. 1.
    Judson MA. Small fiber neuropathy in sarcoidosis: something beneath the surface. Resp Med. 2010;105:1–2.CrossRefGoogle Scholar
  2. 2.
    Hoitsma E, De Vries J, van Santen-Hoeufft M, et al. Impact of pain in a Dutch sarcoidosis patient population. Sarcoid Vasc Diffuse Lung Dis. 2003;20:33–9.Google Scholar
  3. 3.
    Bakkers M, Merkies ISJ, Lauria G, Devigili G, Penza P, Lombardi R, et al. Intraepidermal nerve fiber density and its application in sarcoidosis. Neurology. 2009;73:1142–8.PubMedCrossRefGoogle Scholar
  4. 4.
    • Tavee J, Zhou L. Small fiber neuropathy: a burning problem. Cleveland Clinic J Med 2009;76:297-305. This is a general review of small-fiber neuropathy diagnosis and treatment options. CrossRefGoogle Scholar
  5. 5.
    Burns TM, Dyck PHB, Aksamit AJ, Dyck PJ. The natural history and long-term outcome of 57 limb sarcoidosis neuropathy cases. J Neurolog Sci. 2006;244:77–87.CrossRefGoogle Scholar
  6. 6.
    Said G, Lacroix C, Plante-Bordeneuve V, Le Page L, Pico F, Presles O, et al. Nerve granulomas and vasculitis in sarcoid peripheral neuropathy: a clinicopathological study of 11 patients. Brain. 2002;125:264–75.PubMedCrossRefGoogle Scholar
  7. 7.
    Hoitsma E, Faber C, Reulen JPH, Sommer C, De Baets M, Drent M. Small fibre neuropathy in sarcoidosis. Lancet. 2002;359:2085–86.PubMedCrossRefGoogle Scholar
  8. 8.
    • Parambil JG, Tavee JO, Zhou L, Pearson K, Culver DA. Efficacy of intravenous immunoglobulin for small fiber neuropathy associated with sarcoidosis. Resp Med 2010;105:101–105. This article highlights an important treatment option for sarcoidosis small-fiber neuropathy CrossRefGoogle Scholar
  9. 9.
    Hays A. Utility of skin biopsy to evaluate peripheral neuropathy. Curr Neurol Neurosci Rep. 2010;10:101–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Gorson KC, Hermann DN, Tiagaraghan R. etal. Nonlength dependent small fiber neuropathy/ganglionopathy. J Neurol. Neuropsychiatry. 2008;79:163–9.Google Scholar
  11. 11.
    Pain and autonomic dysfunction in patients with sarcoidosis and small fiber neuropathy. J Neurol. 2010;257:2086–90.Google Scholar
  12. 12.
    Smulders NM, Bast A, van Kroonenburgh MJ, Drent M. Improvement of cardiac sympathetic nerve function in sarcoidosis. Sarcoid Vasc Diffuse Lung Dis. 2008;25:140–2.Google Scholar
  13. 13.
    Hoitsma E, Faber C, van Kroonenburgh MJ, Gorgels, APN, Hladers SG, et al. Association of small fiber neuropathy with cardiac sympathetic dysfunction in sarcoidosis. Sarcoid Vasc Diffuse Lung Dis. 2005;43–50.Google Scholar
  14. 14.
    de Kleijn WP, de Vries J, Lower EE. etal. Fatigue in sarcoidosis: a systematic review. Curr Opp. Pulm Med. 2009;15:499–506.CrossRefGoogle Scholar
  15. 15.
    Vital A, Lagueny A, Ferrer X, Louiset P, Canron MH, Vital C. Sarcoid neuropathy: clinico-pathological study of 4 new cases and review of the literature. Clin Neuropath. 2008;27:96–105.Google Scholar
  16. 16.
    Lauria G, Morbin M, Lombardi R, Borgna M. Axonal swellings predict the degeneration of epidermal nerve fibers in painful neuropathies. Neurology. 2003;61:631–6.PubMedGoogle Scholar
  17. 17.
    Sato H, Grutters JC, Pantelidis P, et al. HLA-DQB1*0201: a marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Resp Cell Mol Biol. 2002;27:406–12.Google Scholar
  18. 18.
    Voorter CEM, Drent M, Hoitsma E, Faber KG, van den Berg-Loonen EM. Association of HLA DQB1*0602 in sarcoidosis patients with small fiber neuropathy. Sarcoid Vasc Diffuse Lung Dis. 2005;22:129–32.Google Scholar
  19. 19.
    Sharma KR, Saadia D, Facca AG, Resnick S, Ayaar DR. Diagnostic role of deep tendon reflex measurement in small-fiber neuropathy. J Peripher Nerv Syst. 2007;12:223–31.PubMedCrossRefGoogle Scholar
  20. 20.
    • Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, Broglio L, Graneri E, Lauria G. The diagnostic criteria for small fiber neuropathy: from symptoms to neuropathology. Brain. 2008:1–14. This is an in-depth review of diagnostic procedures and causes for small-fiber neuropathy.Google Scholar
  21. 21.
    McArthur JC, Stocks EA, Hauer P, Cornblath DR, Griffin JW. Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol. 1998;55(12):1513–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Lauria G, Cornblath DR, Johansson O, et al. EFNS Guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy. Eur J Neurol. 2005;12:1–12.CrossRefGoogle Scholar
  23. 23.
    Shy ME, Frohman EM, So YT, Arezzo JC, Cornblatj DR, et al. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003;60:898–904.PubMedGoogle Scholar
  24. 24.
    Peltier A, Smith AG, Russell JW, Sheikh K, Bixby B, et al. Reliability of quantitative sudomotor axon reflex testing and quantitative sensory testing in neuropathy of impaired glucose regulation. Muscle Nerve. 2009;39:529–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Low VA, Sandroni P, Fealey RD, Low PA. Detection of small-fiber neuropathy by sudomotor testing. Muscle Nerve. 2006;34(1):57–61.PubMedCrossRefGoogle Scholar
  26. 26.
    Novak V, Freimer ML, Kissel JT, Sahenk Z, Periquet IM, Nash SM, et al. Autonomic impairment in painful neuropathy. Neurology. 2001;56(7):861–8.PubMedGoogle Scholar
  27. 27.
    Hoitsma E, Faber C, van Santen-Houefft M, DeVries J, Reulen JPH, Drent M. Improvement of small fiber neuropathy in a sarcoidosis patient after treatment with infliximab. Sarcoid Vasc Diffuse Lung Dis. 2006;23:73–7.Google Scholar
  28. 28.
    Heaney D, Geddes J, Nagendren K, Swash M. Sarcoid polyneuropathy responsive to intravenous immunoglobulin.Google Scholar
  29. 29.
    Hoitsma E, Faber C, Drent M, Sharma OP. Neurosarcoidosis: a clinical dilemma. Lancet Neurol. 2004;3:397–407.PubMedCrossRefGoogle Scholar
  30. 30.
    Tavee J, Rensel M, Pope Planchon S, Stone L. Effects of Meditation on Pain and Quality of Life in Multiple Sclerosis and Polyneuropathy: A controlled study. Neurology. 2010;74(S2):A160.Google Scholar
  31. 31.
    Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Cleveland Clinic FoundationNeuromuscular CenterClevelandUSA
  2. 2.Cleveland Clinic FoundationRespiratory InstituteClevelandUSA

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