Small nerve fiber involvement in systemic lupus erythematosus: a controlled study.
OBJECTIVE
To determine if patients with systemic lupus erythematosus (SLE) may have a peripheral neuropathy involving unmyelinated and small, myelinated nerve fibers, by immunostaining epidermal nerve fibers (ENF) in skin biopsy samples for the panaxonal marker, protein gene product 9.5 (PGP 9.5).


METHODS
Fifteen consecutive and nonselected SLE patients and 15 age- and sex-matched controls were included in the study. The age of the patients ranged from 25 years to 65 years, with a mean +/- SD age of 47.3 +/- 10.2 years and a disease duration of 2-28 years (mean +/- SD 14.8 +/- 8.6 years). Two 3-mm skin biopsy samples were obtained with a punch needle approximately 10 cm superior to the lateral malleolus of the right leg and immunostained with 0.1% rabbit polyclonal antibodies to human PGP 9.5. The number of ENF per millimeter was counted and recorded as the mean +/- SD of counts in six 50-microm sections, 3 from each of the 2 biopsy samples.


RESULTS
The mean number of ENF per mm in patients with SLE was 8.0 +/- 1.5 (range 5.0-9.9), while the matched controls had 12.2 +/- 3.8 ENF per mm (range 6.8-18.6) (P = 0.0006).


CONCLUSIONS
This study indicates that a small fiber involvement in patients with SLE may be responsible for the prevalent neuropathic symptoms and impaired warm sense that is observed in such patients.
Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway. romdal@online.no
Roald
R
Omdal
Svein Ivar
SI
Mellgren
Lasse
L
Gøransson
Astrid
A
Skjesol
Sigurd
S
Lindal
Wenche
W
Koldingsnes
Gunnar
G
Husby
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000737:chemistry / Q000473:pathology*; D010523:Peripheral Nervous System Diseases / Q000473:pathology*; D012867:Skin / Q000294:innervation*; D013869:Thiolester Hydrolases / Q000032:analysis; D043222:Ubiquitin Thiolesterase
D000893:Anti-Inflammatory Agents; D013869:Thiolester Hydrolases; D043222:Ubiquitin Thiolesterase