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Egyptian Rheumatology and Rehabilitation
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Upper extremity subclinical autonomic and peripheral neuropathy in systemic lupus erythematosus

Egyptian Rheumatology and Rehabilitation volume 42, pages 87–93 (2015)Cite this article

Abstract

Background

Systemic lupus erythematosus (SLE) is an autoimmune, multiorgan disease that affects connective tissues of many organs or systems, including the nervous system, where it affects the autonomic, the peripheral, and the central nervous system.

Objective

The aim of this study was to investigate the association of subclinical autonomic and peripheral neuropathy with SLE and to correlate neurophysiological parameters with clinical and laboratory data.

Patients and methods

Fifty-six SLE patients were included in this study. In addition, thirty age-matched and sex-matched healthy participants served as a control group. Exclusion criteria included patients having symptoms or signs indicating autonomic dysfunction or peripheral neuropathy. Also, endocrinal, toxic, compression, and traumatic neuropathies were excluded. Patients were assessed clinically and by laboratory investigations. Neurophysiological assessment included sympathetic skin response of the median nerve including latency and amplitude. In addition, nerve conduction study of both median and ulnar nerves was performed including motor distal latency, amplitude, nerve conduction velocity, and distal sensory latency.

Results

Pure sensory abnormality was detected in one patient, whereas pure motor neuropathy was found in 19 patients. Mixed sensory–motor abnormalities were detected in two patients. Sympathetic skin response was not elicited in 13 patients, whereas latency and amplitude abnormalities were detected in 11/43 and 9/43 patients, respectively. Sympathetic and axonal neuropathy was not correlated with the disease duration or the disease activity.

Conclusion

The pattern of neuropathy in SLE is mainly axonal. Also, the sympathetic nervous system is affected in lupus patients with a rate of up to 40% of the cases.

References

  1. Gøransson LG, Tjensvoll AB, Herigstad A, Mellgren SI, Omdal R. Small-diameter nerve fiber neuropathy in systemic lupus erythematosus. Arch Neurol 2006; 63:401–404.

    Article  Google Scholar 

  2. Fietta P, Fietta P, Delsante G. Psychiatric and neuropsychological manifestations of systemic lupus erythematosus. Acta Biomed 2011; 82:97–114.

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  4. American College of Rheumatology. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42:599–608.

    Article  Google Scholar 

  5. Meroni PL, Tincani A, Sepp N, Raschi E, Testoni C, Corsini E, et al. Endothelium and the brain in CNS lupus. Lupus 2003; 12:919–928.

    Article  CAS  Google Scholar 

  6. Scolding NJ, Joseph FG. The neuropathology and pathogenesis of systemic lupus erythematosus. Neuropathol Appl Neurobiol 2002; 28:173–189.

    Article  CAS  Google Scholar 

  7. Navarrete MG, Brey RL. Neuropsychiatric systemic lupus erythematosus. Curr Treat Options Neurol 2000; 2:473–485.

    Article  CAS  Google Scholar 

  8. Hanly JG. Neuropsychiatric lupus. Curr Rheumatol Rep 2001; 3:205–212.

    Article  CAS  Google Scholar 

  9. Hanly JG, Urowitz MB, Sanchez-Guerrero J, Bae SC, Gordon C, Wallace DJ, et al. Systemic Lupus International Collaborating Clinics Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study. Arthritis Rheum 2007; 56:265–273.

    Article  CAS  Google Scholar 

  10. Crone C, Krarup C. Neurophysiological approach to disorders of peripheral nerve. Handb Clin Neurol 2013; 115:81–114.

    Article  Google Scholar 

  11. Louthrenoo W, Ruttanaumpawan P, Aramrattana A, Sukitawut W. Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus. QJM 1999; 92:97–102.

    Article  CAS  Google Scholar 

  12. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res 2003; 13: 256–270.

    Article  Google Scholar 

  13. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25:1271–1277.

    Article  CAS  Google Scholar 

  14. Syngle A, Verma I, Garg N, Krishan P. HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed/23549640” Autonomic dysfunction in psoriatic arthritis. Clin Rheumatol 2013 Jul; 32:1059-64. doi: 10.1007/s10067-013-2239-x. Epub 2013 Apr 3. PMID: 23549640.

  15. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992; 35:630–640.

    Article  CAS  Google Scholar 

  16. Claus D, Schondorf R. Sympathetic skin response. In: Deuschl G, Eisen A, editors. Recommendation for the practice of clinical neurophysiology: guidelines of the International Federation of Clinical Neurophysiology. 2nd ed. Volume 52: Elsevier; 1999. 277–285.

  17. Ellaway PH, Kuppuswamy A, Nicotra A, Mathias CJ. Sweat production and the sympathetic skin response: Improving the clinical assessment of autonomic function. Auton Neurosci 2010; 155:109–114.

    Article  CAS  Google Scholar 

  18. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, Wilson JR. Second American Association of Electrodiagnostic Medicine literature review of the usefulness of nerve conduction studies and needle electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 2002; 26:S1–S53.

    Article  Google Scholar 

  19. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2002; 25:918–922.

    Article  Google Scholar 

  20. Leszczynski P, Pawlak-Bus K. Vocal cords palsy in systemic lupus erythematosus patient: diagnostic and therapeutic difficulties. Rheumatol Int 2013; 33:1577–1580.

    Article  Google Scholar 

  21. Franssen H, van den Bergh PY. Nerve conduction studies in polyneuropathy: practical physiology and patterns of abnormality. Acta Neurol Belg 2006; 106:73–81.

    PubMed  Google Scholar 

  22. Johnsen B, Fuglsang-Frederiksen A. Electrodiagnosis of polyneuropathy. Neurophysiol Clin 2000; 30:339–351.

    Article  CAS  Google Scholar 

  23. Shehata GA, Elserogy YM, Ahmad HE, Abdel-Kareem MI, Al-Kabeer AM, Rayan MM, El-Baky ME. Multimodal neurophysiological and psychometric evaluation among patients with systemic lupus erythematosus. Int J Gen Med 2011; 4:325–332.

    Article  Google Scholar 

  24. Aslam F, Bannout F, Russell EB. Cranial nerve palsies: sarcoidosis to systemic lupus erythematosus. Case Rep Rheumatol 2013; 2013:175261.

    Google Scholar 

  25. Stojanovich L. Autonomic dysfunction in autoimmune rheumatic disease. Autoimmun Rev 2009; 8:569–572.

    Article  CAS  Google Scholar 

  26. Bertinotti L, Pietrini U, Del Rosso A, Casale R, Colangelo N, Zoppi M, Matucci-Cerinic M. The use of pupillometry in joint and connective tissue diseases. Ann N Y Acad Sci 2002; 966:446–455.

    Article  Google Scholar 

  27. Tekatas A, Koca SS, Tekatas DD, Aksu F, Dogru Y, Pamuk ON. R–R interval variation and sympathetic skin response in systemic lupus erythematosus. Clin Rheumatol 2014; 33:65–70.

    Article  Google Scholar 

  28. Stojanovich L, Milovanovich B, de Luka SR, Popovich-Kuzmanovich D, Bisenich V, Djukanovich B, et al. Cardiovascular autonomic dysfunction in systemic lupus, rheumatoid arthritis, primary Sjögren syndrome and other autoimmune diseases. Lupus 2007; 16:181–185.

    Article  CAS  Google Scholar 

  29. Aydemir M, Yazisiz V, Basarici I, Avci AB, Erbasan F, Belgi A, Terzioglu E. Cardiac autonomic profile in rheumatoid arthritis and systemic lupus erythematosus. Lupus 2010; 19:255–261.

    Article  CAS  Google Scholar 

  30. Milovanović B, Stojanović L, Milićevik N, Vasić K, Bjelaković B, Krotin M. Cardiac autonomic dysfunction in patients with systemic lupus, rheumatoid arthritis and sudden death risk. Srp Arh Celok Lek 2010; 138:26–32.

    Article  Google Scholar 

  31. Greenwood DL, Gitlits VM, Alderuccio F, Sentry JW, Toh BH. Autoantibodies in neuropsychiatric lupus. Autoimmunity 2002; 35: 79–86.

    Article  CAS  Google Scholar 

  32. Yoshio T, Hirata D, Onda K, Nara H, Minota S. Antiribosomal P protein antibodies in cerebrospinal fluid are associated with neuropsychiatric systemic lupus erythematosus. J Rheumatol 2005; 32:34–39.

    CAS  PubMed  Google Scholar 

  33. Arinuma Y, Yanagida T, Hirohata S. Association of cerebrospinal fluid anti-NR2 glutamate receptor antibodies with diffuse neuropsychiatric systemic lupus erythematosus. Arthritis Rheum 2008; 58:1130–1135.

    Article  CAS  Google Scholar 

  34. Vincent A, Dalton P, Clover L, Palace J, Lang B. Antibodies to neuronal targets in neurological and psychiatric diseases. Ann N Y Acad Sci 2003; 992:48–55.

    Article  CAS  Google Scholar 

  35. Sakic B, Kirkham DL, Ballok DA, Mwanjewe J, Fearon IM, Macri J, et al. Proliferating brain cells are a target of neurotoxic CSF in systemic autoimmune disease. J Neuroimmunol 2005; 169:68–85.

    Article  CAS  Google Scholar 

  36. Rocca MA, Agosta F, Mezzapesa DM, Ciboddo G, Falini A, Comi G, Filippi M. An fMRI study of the motor system in patients with neuropsychiatric systemic lupus erythematosus. Neuroimage 2006; 30:478–484.

    Article  Google Scholar 

  37. Jennekens FG, Kater L. The central nervous system in systemic lupus erythematosus. Part 2. Pathogenetic mechanisms of clinical syndromes: a literature investigation. Rheumatology (Oxford) 2002; 41:619–630.

    Article  CAS  Google Scholar 

  38. Weiner SM, Peter HH. Neuropsychiatric involvement in systemic lupus erythematosus. Part 1: clinical presentation and pathogenesis. Med Klin (Munich) 2002; 97:730–737.

    Article  CAS  Google Scholar 

  39. Ballok DA. Neuroimmunopathology in a murine model of neuropsychiatric lupus. Brain Res Rev 2007; 54:67–79.

    Article  CAS  Google Scholar 

  40. Muscal E, Brey RL. Neurologic manifestations of systemic lupus erythematosus in children and adults. Neurol Clin 2010; 28:61–73.

    Article  Google Scholar 

  41. Levy Y, Uziel Y, Zandman GG, Amital H, Sherer Y, Langevitz P, et al. Intravenous immunoglobulins in peripheral neuropathy associated with vasculitis. Ann Rheum Dis 2003; 62:1221–1223.

    Article  CAS  Google Scholar 

  42. Luyendijk J, Steens SC, Ouwendijk WJ, Steup-Beekman GM, Bollen EL, van der Grond J, et al. Neuropsychiatric systemic lupus erythematosus: lessons learned from magnetic resonance imaging. Arthritis Rheum 2011; 63:722–732.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mahmoud M. Fathalla MD & Mohja A. El-Badawy

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  1. Mahmoud M. Fathalla MD
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  2. Mohja A. El-Badawy
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Correspondence to Mahmoud M. Fathalla MD.

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Fathalla, M.M., El-Badawy, M.A. Upper extremity subclinical autonomic and peripheral neuropathy in systemic lupus erythematosus. Egypt Rheumatol Rehabil 42, 87–93 (2015). https://doi.org/10.4103/1110-161X.157868

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  • DOI: https://doi.org/10.4103/1110-161X.157868

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