Small-diameter nerve fiber neuropathy in systemic lupus erythematosus

Arch Neurol. 2006 Mar;63(3):401-4. doi: 10.1001/archneur.63.3.401.


Background: Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune, multiorgan disease often involving the central and peripheral nervous systems.

Objective: To determine whether there is a selective small-diameter nerve fiber neuropathy in patients with SLE.

Design: Cross-sectional study.

Setting: Stavanger University Hospital, Stavanger, Norway. Patients Sixty patients with SLE, aged 43.2 +/- 13.5 years (mean +/- SD).

Interventions: Skin biopsies, nerve conduction studies, and clinical neurologic examinations.

Main outcome measures: Density of intraepidermal small-diameter nerve fibers in skin biopsy specimens and large-diameter nerve fiber function as determined by nerve conduction studies and clinical examinations.

Results: The mean density of intraepidermal small-diameter nerve fibers in patients with SLE was 7.5 +/- 3.8/mm. Eight patients (13%) had densities below reference values, consistent with small-diameter nerve fiber neuropathy, and results of nerve conduction studies were normal in 6 of them. Eleven patients (18%) had abnormal results of nerve conduction studies, reflecting large-diameter nerve fiber neuropathy, and 4 patients (7%) were classified by an experienced neurologist as having polyneuropathy after the clinical examination.

Conclusions: An abnormal reduction in intraepidermal small-diameter nerve fiber densities is evident in some patients despite normal function of their larger nerve fibers. This adds further support to the theory that a pure small-diameter nerve fiber neuropathy may occur in SLE.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biopsy / methods
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / pathology*
  • Male
  • Middle Aged
  • Nerve Fibers / pathology*
  • Nerve Fibers / physiology
  • Neural Conduction / physiology
  • Peripheral Nervous System Diseases / etiology
  • Peripheral Nervous System Diseases / pathology*
  • Retrospective Studies
  • Skin / innervation
  • Skin / pathology