1
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Fujioka T, Kondo K, Kohara N. Subacute Progressive Severe Ataxic Sensory Neuropathy with Sjögren's Syndrome. Intern Med 2024; 63:1637-1643. [PMID: 37926550 DOI: 10.2169/internalmedicine.2226-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
We herein report a 79-year-old woman with subacute progressive ataxic sensory neuropathy. The patient's symptoms began with numbness in the lower extremities, which rapidly deteriorated, resulting in gait disturbance and abnormal sensations in the extremities, reaching a peak over a period of approximately two months. Nerve conduction studies revealed pure axonal-type sensory polyneuropathy. The expeditious progression of the disease initially prompted suspicion of Guillain-Barré syndrome or paraneoplastic syndrome. Nevertheless, after comprehensive evaluations, the conclusive diagnosis was confirmed as ataxic sensory neuropathy with Sjögren's syndrome. Intensive immunotherapy was administered; however, it was ineffective in halting disease progression. Consequently, this case underscores the significance of an early comprehensive diagnosis and prompt immunotherapy for ataxic sensory neuropathy associated with Sjögren's syndrome.
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Affiliation(s)
| | | | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
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2
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Saied Z, Zouari R, Rachdi A, Nabli F, Ben Mohamed D, Ben Sassi S. Cerebral large vessels vasculitis following Guillain-Barré syndrome as first clinical manifestations of primary Sjogren's syndrome: A case based - Review. Heliyon 2024; 10:e30004. [PMID: 38698975 PMCID: PMC11064453 DOI: 10.1016/j.heliyon.2024.e30004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
Background Primary Sjogren's syndrome (pSS) is an autoimmune exocrinopathy in which extraglandular signs of pSS are determinant for the prognosis. Involvement of both peripheral and central nervous system (CNS) are known to be among the sites of high systemic activity in pSS. Case presentation We, herein, report a case of a 57-year-old female patient with pSS presenting with typical Guillan-Barré syndrome (GBS), shortly followed by acute headaches accompanied by cortical blindness. Cerebral magnetic resonance imaging (MRI) demonstrated T2 signal abnormalities on the occipital region with narrowing and irregularities of the cerebral arteries, suggestive of CNS vasculitis.Subtle sicca symptoms occurring prior to neurological symptoms by 8 months together with immunological disturbances (anti-SSA, anti-SSB antibodies positivity, type II cryoglobulins positivity, and C4 hypocomplementemia) allowed us to retain the diagnosis of pSS. Recovery of motor symptoms was possible under the combined use of immunoglobulins and corticotherapy during the initial phase. A three-years follow-up confirmed progressive motor recovery and stabilization under 6-months cyclophosphamide cycles relayed by azathioprine therapy. Conclusions Neurological complications can be inaugural in lead to urgent investigations and treatment. Peripheral and central neurological manifestations can coexist. The approach should integrate careful clinical assessment, as well as radiological and immunological findings.
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Affiliation(s)
- Zakaria Saied
- National Institute Mongi Ben Hamida of Neurology of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Rania Zouari
- National Institute Mongi Ben Hamida of Neurology of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Amine Rachdi
- National Institute Mongi Ben Hamida of Neurology of Tunis, Tunisia
| | - Fatma Nabli
- National Institute Mongi Ben Hamida of Neurology of Tunis, Tunisia
| | - Dina Ben Mohamed
- National Institute Mongi Ben Hamida of Neurology of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Samia Ben Sassi
- National Institute Mongi Ben Hamida of Neurology of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
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3
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Sanchez V, Dobzinski N, Fox R, Galor A. Rethinking Sjögren Beyond Inflammation: Considering the Role of Nerves in Driving Disease Manifestations. Eye Contact Lens 2024; 50:200-207. [PMID: 38350094 PMCID: PMC11045324 DOI: 10.1097/icl.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/15/2024]
Abstract
ABSTRACT Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease characterized by destruction of mucosal glands resulting in dry eye and dry mouth. Ocular presentations can be heterogenous in SS with corneal nerves abnormalities that are structural, functional, or both. Some individuals present with corneal hyposensitivity, with a phenotype of decreased tear production and epithelial disruption. Others present with corneal hypersensitivity, with a phenotype of neuropathic pain including light sensitivity and pain out of proportion to signs of tear dysfunction. A similar correlate can be found outside the eye, with dry mouth predominating in some individuals while pain conditions predominate in others. Understanding how nerve status affects SS phenotype is an important first step to improving disease management by targeting nerve abnormalities, as well as inflammation.
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Affiliation(s)
- Victor Sanchez
- New York University Grossman School of Medicine, New York, NY, 10016
| | - Noa Dobzinski
- Miami Veterans Administration Medical Center, Miami, FL, 33125
| | - Robert Fox
- Rheumatology, Scripps Memorial Hospital and Research Foundation, La Jolla, CA, 92037
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, 33125
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, 33163
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4
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Murahashi M, Ntege EH, Ide K, Maruyama N, Shirakawa J, Koyama H, Kawano T, Goto T, Shimizu Y, Nishihara K, Nakamura H. Metastatic gallbladder cancer presenting as numb chin syndrome: A case report and literature review. Biomed Rep 2024; 20:61. [PMID: 38476609 PMCID: PMC10928479 DOI: 10.3892/br.2024.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024] Open
Abstract
Gallbladder cancer (GBC) is an uncommon malignancy that is highly aggressive in the advanced stages. However, it rarely metastasizes to the mandible. Numb chin syndrome (NCS) is a rare neurological manifestation associated with various underlying causes, including occult primary cancers and distant metastases. It is often considered to be a significant indicator of malignancy, and thorough investigation is essential in the presence of unclear etiology. The current study reported on the case of a 69-year-old Japanese woman who presented with numbness and mild pain in the lower lip and chin area for three months. No other systemic symptoms were observed. Immunocytochemical examination revealed the presence of an adenocarcinoma and TNM staging as per the Union for International Cancer Control and the American Joint Committee on Cancer guidelines confirmed stage IVb GBC. Comprehensive full-body positron emission tomography-computed tomography examination using 18F-fluoro-2-deoxy-D-glucose revealed additional bone and soft-tissue metastases. Palliative chemotherapy and radiation treatment were initiated based on the advanced stage of disease at the time of diagnosis. However, the patient succumbed to multiple organ failure six months later. The simultaneous occurrence of GBC, mandibular metastasis and NCS is rare and associated with poor prognosis. Despite the widespread nature of the disease, it can often manifest as non-specific oral symptoms without any systemic indications. The current study emphasizes the critical importance of timely confirmatory testing for accurate diagnosis and initiation of appropriate management for such complex conditions.
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Affiliation(s)
- Makoto Murahashi
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, Okinawa Red Cross Hospital, Naha, Okinawa 902-8588, Japan
| | - Edward Hosea Ntege
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kentaro Ide
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jumpei Shirakawa
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Hiroki Koyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takahiro Goto
- Department of Oral and Maxillofacial Surgery, Okinawa Red Cross Hospital, Naha, Okinawa 902-8588, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Surgery, Okinawa Red Cross Hospital, Naha, Okinawa 902-8588, Japan
| | - Hiroyuki Nakamura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
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5
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Alberti C, Spagliardi J, Barbic F, Doneddu PE, Cutellè C, Furlan R, Nobile-Orazio E. Autonomic neuropathy improving after intravenous immunoglobulin therapy. Clin Auton Res 2024; 34:311-316. [PMID: 38733551 DOI: 10.1007/s10286-024-01034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Claudia Alberti
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Jacopo Spagliardi
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
| | - Claudia Cutellè
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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6
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Antoine JC. Inflammatory sensory neuronopathies. Rev Neurol (Paris) 2024:S0035-3787(24)00455-7. [PMID: 38472032 DOI: 10.1016/j.neurol.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 03/14/2024]
Abstract
Inflammatory sensory neuronopathies are rare disorders mediated by dysimmune mechanisms targeting sensory neurons in the dorsal root ganglia. They constitute a heterogeneous group of disorders with acute, subacute, or chronic courses, and occur with cancer, systemic autoimmune diseases, notably Sjögren syndrome, and viral infections but a noticeable proportion of them remains isolated. Identifying inflammatory sensory neuronopathies is crucial because they have the potential to be stabilized or even to improve with immunomodulatory or immunosuppressant treatments provided that the treatment is applied at an early stage of the disease, before a definitive degeneration of neurons. Biomarkers, and notably antibodies, are crucial for this early identification, which is the first step to develop therapeutic trials.
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Affiliation(s)
- J-C Antoine
- Department of Neurology, University Hospital of Saint-Etienne, 42055 Saint-Étienne cedex, France.
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7
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Castellazzi M, Candeloro R, Pugliatti M, Govoni M, Silvagni E, Bortoluzzi A. Cerebrospinal Fluid Analysis in Rheumatological Diseases with Neuropsychiatric Complications and Manifestations: A Narrative Review. Diagnostics (Basel) 2024; 14:242. [PMID: 38337758 PMCID: PMC10854855 DOI: 10.3390/diagnostics14030242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
The analysis of cerebrospinal fluid (CSF) remains a valuable diagnostic tool in the evaluation of inflammatory and infectious conditions involving the brain, spinal cord, and meninges. Since many rheumatic inflammatory diseases can involve the central and peripheral nervous system, the aims of this narrative review were to summarize the latest evidence on the use of CSF analysis in the field of neuropsychiatric manifestations of rheumatic diseases. Routine CSF parameters were taken into consideration for this review: appearance; total protein and cellular content (pleocytosis); lactate and/or glucose; CSF/serum albumin quotient; intrathecal synthesis of IgG. Data regarding the role of CSF analysis in the clinical management of neuropsychiatric systemic lupus erythematosus, primary Sjogren's syndrome, rheumatoid arthritis, and Behçet's syndrome are presented. Although no disease-specific picture has been identified, CSF analysis remains a useful diagnostic tool to confirm the presence of a neuro-inflammatory state or, conversely, to exclude the concomitant presence of other inflammatory/infectious diseases affecting the CNS in the context of systemic rheumatologic conditions.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Raffaella Candeloro
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Marcello Govoni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
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8
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Moltoni G, Romano A, Blandino A, Palizzi S, Romano A, D'Arrigo B, Guarnera A, Dellepiane F, Frezza V, Gagliardo O, Tari Capone F, Grossi A, Trasimeni G, Bozzao A. Extra-axial cranial nerve enhancement: a pattern-based approach. LA RADIOLOGIA MEDICA 2024; 129:118-132. [PMID: 37882918 PMCID: PMC10808254 DOI: 10.1007/s11547-023-01734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Cranial nerve enhancement is a common and challenging MRI finding that requires a meticulous and systematic evaluation to identify the correct diagnosis. Literature mainly describes the various pathologies with the associated clinic-radiological characteristics, while the radiologist often needs a reverse approach that starts from the radiological findings to reach the diagnosis. Therefore, our aim is to provide a new and practical pattern-based approach to cranial nerve enhancement, which starts from the radiological findings and follows pattern-driven pipelines to navigate through multiple differential diagnoses, guiding the radiologist to reach the proper diagnosis. Firstly, we reviewed the literature and identified four patterns to categorize the main pathologies presenting with cranial nerve enhancement: unilateral linear pattern, bilateral linear pattern, unilateral thickened pattern, and bilateral thickened pattern. For each pattern, we describe the underlying pathogenic origin, and the main radiological features are displayed through high-quality MRI images and illustrative panels. A suggested MRI protocol for studying cranial nerve enhancement is also provided. In conclusion, our approach for cranial nerve enhancement aims to be an easy tool immediately applicable to clinical practice for converting challenging findings into specific pathological patterns.
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Affiliation(s)
- Giulia Moltoni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy.
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy.
| | - Andrea Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Antonella Blandino
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Serena Palizzi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Allegra Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | | | - Alessia Guarnera
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Francesco Dellepiane
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Valentina Frezza
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Olga Gagliardo
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Francesca Tari Capone
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Andrea Grossi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Guido Trasimeni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
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9
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Lagtarna H, Naji Y, Adali N. Cranial Neuropathy As Initial Manifestation of Primary Sjögren's Syndrome: A Case Series With Literature Review. Cureus 2024; 16:e53063. [PMID: 38410309 PMCID: PMC10896272 DOI: 10.7759/cureus.53063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
The clinical spectrum of primary Sjögren's syndrome (PSS) extends beyond its classical manifestations. This work explores an unusual aspect of PSS, namely the initial presentation of cranial neuropathy. The study was conducted over a period of 22 months, from January 2022 to October 2023. Of 58 PSS patients, only five (four women and one man) had cranial neuropathy as their initial manifestation. Only one patient had sixth cranial nerve involvement, three had acute optic neuritis (second cranial nerve), and three had fifth cranial nerve involvement. The diagnosis of PSS was retained according to the 2016 ACR-EULAR criteria. All patients received symptomatic and immunosuppressive treatments. The course was favorable for all patients. The purpose of this case series is to show that cranial neuropathy can be the initial manifestation of PSS, which should be systematically investigated after the elimination of the most common etiologies of cranial neuropathy, particularly in the elderly.
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Affiliation(s)
- Hamza Lagtarna
- Neurology Department, Agadir University Hospital, Agadir, MAR
- Neurology Department, REGNE Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Yahya Naji
- Neurology Department, Agadir University Hospital, Agadir, MAR
- Neurology Department, REGNE Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Nawal Adali
- Neurology Department, Agadir University Hospital, Agadir, MAR
- Neurology Department, REGNE Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
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10
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Kataria R, Suja L, Anil AA, Senthil N. Primary Sjogren's syndrome presenting as an isolated severe autonomic dysfunction treated with steroids. BMJ Case Rep 2023; 16:e256412. [PMID: 38087488 PMCID: PMC10729164 DOI: 10.1136/bcr-2023-256412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Primary Sjogren's syndrome (pSS) is an autoimmune connective tissue disorder with multisystem manifestations. We here report a previously healthy woman who presented with autonomic dysfunction in the form of severe dizziness without any apparent sensory neuropathy. Detailed history and examination revealed the signs and symptoms of Sjogren's syndrome such as constipation and dry eyes and mouth, following which anti-SSA and SSB antibodies were found to be positive. Finally, a diagnosis of pSS was established after ruling out all the other causes of autonomic dysfunction in addition to the clinical and laboratory evidence. The patient was treated with the maximum doses of midodrine and fludrocortisone, yet no progress was noticed. Hence, a trial of steroids was started and she showed a significant clinical improvement. Our patient presented with pure autonomic failure associated with Sjogren's syndrome, making it an extremely rare entity.
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Affiliation(s)
- Riya Kataria
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Lakshmanan Suja
- General Medicine, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Archa Anna Anil
- General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Narayanasamy Senthil
- General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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11
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Yin H, Yang S, Lu L. Adie's tonic pupil in primary Sjögren syndrome. Clin Rheumatol 2023; 42:3419-3420. [PMID: 37518192 DOI: 10.1007/s10067-023-06707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Hanlin Yin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Middle Shandong Rd, Shanghai, 200001, China
| | - Shaoying Yang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Middle Shandong Rd, Shanghai, 200001, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Middle Shandong Rd, Shanghai, 200001, China.
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12
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Barsottini OGP, Moraes MPMD, Fraiman PHA, Marussi VHR, Souza AWSD, Braga Neto P, Spitz M. Sjogren's syndrome: a neurological perspective. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1077-1083. [PMID: 38157875 PMCID: PMC10756846 DOI: 10.1055/s-0043-1777105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
Sjogren's syndrome (SS) is a complex autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands, resulting in sicca symptoms. Additionally, SS presents with neurological manifestations that significantly impact the nervous system. This review aims to provide a comprehensive overview of the neurological aspects of SSj, covering both the peripheral and central nervous system involvement, while emphasizing diagnosis, treatment, and prognosis.
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Affiliation(s)
- Orlando Grazianni Povoas Barsottini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Marianna Pinheiro Moraes de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Pedro Henrique Almeida Fraiman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | | | - Alexandre Wagner Silva de Souza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Divisão de Reumatologia, São Paulo SP, Brazil.
- Sociedade Brasileira de Reumatologia, Comissão de Vasculites, São Paulo SP, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brazil.
- Universidade do Estado do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil.
| | - Mariana Spitz
- Universidade do Estado do Rio de Janeiro, Serviço de Neurologia, Rio de Janeiro RJ, Brazil.
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13
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Yu J, Wang S, Yang J, Huang W, Tang B, Peng W, Tian J. Exploring the mechanisms of action of Zengye decoction (ZYD) against Sjogren's syndrome (SS) using network pharmacology and animal experiment. PHARMACEUTICAL BIOLOGY 2023; 61:1286-1297. [PMID: 37606264 PMCID: PMC10446814 DOI: 10.1080/13880209.2023.2248188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023]
Abstract
CONTEXT Zengye decoction (ZYD) has been considered to have a curative effect on Sjogren's syndrome (SS). However, its therapeutic mechanisms remain obscure. OBJECTIVES This research explores the mechanisms of ZYD against SS. MATERIALS AND METHODS The active compounds and targets of ZYD were searched in the TCMSP and BATMAN-TCM databases. SS-related targets were obtained from the GeneCards database. The GO and KEGG enrichment analyses elucidated the molecular mechanisms. Animal experiments were performed using 8 C57BL/6 mice that served as the control group (physiological saline treatment) and 16 NOD mice randomly divided into the model group (physiological saline treatment) and the ZYD group (ZYD treatment) for 8 weeks to verify the therapeutic effects of ZYD on SS. RESULTS Twenty-nine active compounds with 313 targets of ZYD and 1038 SS-related targets were screened. Thirty-two common targets were identified. β-Sitosterol and stigmasterol might be important components. GO analysis suggested that the action of ZYD against SS mainly involved oxidative stress, apoptotic processes, and tumor necrosis factor receptor superfamily binding, etc. KEGG analysis indicated the most significant signaling pathway was apoptosis-multiple species. Animal experiments showed that ZYD improved lymphocytic infiltration of the submandibular glands (SMGs), reduced the serum levels of TNF-α, IL-1β, IL-6, and IL-17, upregulated the expression of Bcl-2, and downregulated the expression of Bax and Caspase-3 in the model mice. DISCUSSION AND CONCLUSION ZYD has anti-inflammatory and anti-apoptotic effects on SS, which provides a theoretical basis for the treatment of SS with ZYD.
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Affiliation(s)
- Jiake Yu
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuying Wang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Yang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wuxinrui Huang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Beikang Tang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijun Peng
- Department of Integrated Traditional Chinese and Western Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Tian
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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14
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Nortey J, Tsang A, Lopez S, Gebreegziabher E, Keenan JD, Lietman T, Gonzales JA. Central Corneal Subbasal Nerve Plexus Abnormalities in Sjögren Disease: A Pilot Study. Cornea 2023; 42:1432-1438. [PMID: 36747319 PMCID: PMC10404635 DOI: 10.1097/ico.0000000000003248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE Small-fiber neuropathy (SFN) is known to be associated with Sjögren disease (SjD), and in vivo corneal confocal microscopy can identify features compatible with SFN. Here, we performed a descriptive study to identify features of SFN of the corneal subbasal nerve plexus using in vivo confocal microscopy. METHODS We recruited 10 participants from the Sjögren's International Collaborative Clinical Alliance (SICCA), 1 new participant (in an effort to expand the SICCA cohort), and 22 healthy controls. All participants underwent slit-lamp examination and in vivo confocal microscopy of the central corneal subbasal nerve plexus centered about the central whorl to create a 30-image montage. Each image was analyzed with automated software (ACCmetrics, Manchester, United Kingdom) to produce 7 nerve metrics. We performed t-tests and age-adjusted regressions to make comparisons of nerve metrics between participants with SjD and healthy controls. RESULTS Most nerve metrics were significantly lower in participants with SjD compared with healthy controls. The mean corneal nerve fiber density was found to be 3.5 mm/mm 2 in participants with SjD compared with 10.6 mm/mm 2 in healthy controls (95% confidence interval, -8.4 to -0.93; P = 0.02). Within the 11 participants with SjD, 22 eyes were analyzed on confocal microscopy, and 16 of those eyes (from 9 individuals) did not have an identifiable central whorl. Within the 22 healthy controls, 22 eyes (right eye alone) were analyzed on confocal microscopy, and 21 of those eyes had an identifiable central whorl. CONCLUSIONS SjD exhibits lower corneal nerve metrics compared with healthy controls. These findings suggest that features compatible with SFN can distinguish SjD from healthy controls and may serve as a potential novel biomarker in identifying SjD.
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Affiliation(s)
- Jeremy Nortey
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Adrian Tsang
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - Sarah Lopez
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | | | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - Tom Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
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15
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Tracy JA. Autoimmune Axonal Neuropathies. Continuum (Minneap Minn) 2023; 29:1378-1400. [PMID: 37851035 DOI: 10.1212/con.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article reviews autoimmune axonal neuropathies, their characteristic clinical features, disease and antibody associations, appropriate ancillary testing, treatment, and prognosis. LATEST DEVELOPMENTS In 2021, the American College of Rheumatology and the Vasculitis Foundation released new summary guidelines for the treatment of antineutrophil cytoplasmic autoantibody-associated vasculitides. In addition, novel autoantibodies have been recently identified; they are often paraneoplastic and associated with axonal neuropathies. ESSENTIAL POINTS Recognition of autoimmune axonal neuropathies is important because of the potential for effective treatment to either reverse deficits or slow the progression of disease. It is necessary to properly assess for associations with other systemic disorders (eg, systemic vasculitis, connective tissue disease, neoplasm) so that adequate treatment for both neurologic and non-neurologic aspects of the disease can be initiated.
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16
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Tamanini JVG, Sabino JV, Cordeiro RA, Mizubuti V, Villarinho LDL, Duarte JÁ, Pereira FV, Appenzeller S, Damasceno A, Reis F. The Role of MRI in Differentiating Demyelinating and Inflammatory (not Infectious) Myelopathies. Semin Ultrasound CT MR 2023; 44:469-488. [PMID: 37555683 DOI: 10.1053/j.sult.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Demyelinating and inflammatory myelopathies represent a group of diseases with characteristic patterns in neuroimaging and several differential diagnoses. The main imaging patterns of demyelinating myelopathies (multiple sclerosis, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, and myelin oligodendrocyte glycoprotein antibody-related disorder) and inflammatory myelopathies (systemic lupus erythematosus-myelitis, sarcoidosis-myelitis, Sjögren-myelitis, and Behçet's-myelitis) will be discussed in this article, highlighting key points to the differential diagnosis.
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Affiliation(s)
| | - João Vitor Sabino
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Sao Paulo University, SP, Brazil
| | - Vanessa Mizubuti
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Juliana Ávila Duarte
- Department of Radiology and Diagnostic Imaging, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Veloso Pereira
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Alfredo Damasceno
- Department of Neurology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Fuster E, Blitshteyn S. A tale of two syndromes: nontraumatic Frey's syndrome in a woman with Sjögren's syndrome. Clin Auton Res 2023; 33:539-541. [PMID: 37264230 DOI: 10.1007/s10286-023-00952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Emily Fuster
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Svetlana Blitshteyn
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
- Dysautonomia Clinic, Williamsville, NY, USA.
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18
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Nakamura H, Tanikawa Y, Nishihara M, Tsukamoto M, Nagasawa Y, Akiya K, Natori N, Kitamura N, Takayama T, Nakajima H. Aseptic meningitis followed by mononeuritis multiplex in a patient with primary Sjögren's syndrome. J Int Med Res 2023; 51:3000605231189121. [PMID: 37548380 PMCID: PMC10408315 DOI: 10.1177/03000605231189121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
A 38-year-old woman was admitted to hospital because of fever and headache. Increased cerebrospinal cell count and protein without evidence of infection led to a diagnosis of aseptic meningitis. Although she improved with acyclovir and glyceol, she experienced left forearm pain and sensory disturbance with drop fingers. Poor derivation of compound muscle action potentials in the left radial nerve was observed, leading to a diagnosis of mononeuritis multiplex with sensorimotor neuropathy. Because the patient had primary Sjögren's syndrome with anti-Ro/SS-A antibody and salivary gland hypofunction, treatment with methylprednisolone, intravenous immunoglobulin, and intravenous cyclophosphamide was followed by oral glucocorticoid therapy. After these intensive therapies, her drop fingers gradually improved, although sensory disturbance remained. In conclusion, we report a case of aseptic meningitis and subsequent mononeuritis multiplex that was successfully treated with intensive immunotherapy in a patient with primary Sjögren's syndrome.
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Affiliation(s)
- Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Tanikawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Nishihara
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masako Tsukamoto
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Nagasawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kumiko Akiya
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naotoshi Natori
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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19
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Lee AYS, Wang JJ, Gordon TP, Reed JH. Phases and Natural History of Sjögren's Disease: A New Model for an Old Disease? Arthritis Care Res (Hoboken) 2023; 75:1580-1587. [PMID: 36063396 PMCID: PMC10953327 DOI: 10.1002/acr.25011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
Sjögren's disease (SjD) is an archetypal and heterogenous autoimmune disorder that is characterized by exocrine glandular dysfunction. A proportion of patients develop severe extraglandular manifestations, such as cryoglobulinemia, and have an increased risk of lymphoma, both of which can adversely affect quality of life and occasionally mortality. As with most autoimmune disorders, the pathogenesis is poorly understood and difficult to predict, and, frustratingly, there is a lack of targeted therapies to cure this disease. We review the disease manifestations of SjD and propose a staged model for understanding the evolution of pathology. In longitudinal studies, most patients remain relatively stable in terms of their laboratory and clinical parameters. However, in the setting of various risk factors, a proportion of patients develop severe symptoms and/or lymphoma. We discuss potential underlying mechanisms for disease progression and the strengths and limitations of using a staged model to correlate the pathogenesis and spectrum of manifestations in SjD. Ultimately, understanding how and why some patients remain relatively stable, whereas others progress and develop florid systemic disease and a fraction develop lymphoma, is key to developing preventative and therapeutic treatments.
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Affiliation(s)
- Adrian Y. S. Lee
- The Westmead Institute for Medical ResearchUniversity of Sydney, Westmead Hospital, NSW Health PathologyWestmeadNew South WalesAustralia
| | - Jing Jing Wang
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tom P. Gordon
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Joanne H. Reed
- The Westmead Institute for Medical ResearchUniversity of SydneyWestmeadNew South WalesAustralia
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20
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Toledano M. Neurologic Manifestations of Rheumatologic Disease. Continuum (Minneap Minn) 2023; 29:734-762. [PMID: 37341329 DOI: 10.1212/con.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This article describes the neurologic manifestations of systemic rheumatologic disorders. LATEST DEVELOPMENTS Although most have historically been classified as autoimmune disorders, rheumatologic diseases are increasingly conceptualized as distributed along a spectrum with various contributions of autoimmune (adaptive immune dysregulation) and autoinflammatory (innate immune dysregulation) mechanisms. Our evolving understanding of systemic immune-mediated disorders has been accompanied by an expansion in our differential diagnoses and therapeutic options. ESSENTIAL POINTS Rheumatologic disease involves both autoimmune and autoinflammatory mechanisms. Neurologic symptoms can be the first manifestation of these disorders, and familiarity with the systemic manifestations of specific diseases is essential to establish the correct diagnosis. Conversely, knowledge of the neurologic syndromes that are most likely to be associated with specific systemic disorders can help narrow the differential and increase confidence when attributing a neuropsychiatric symptom to an underlying systemic disorder.
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21
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Moritz CP, Tholance Y, Vallayer PB, Do LD, Muñiz-Castrillo S, Rogemond V, Ferraud K, La Marca C, Honnorat J, Killian M, Paul S, Camdessanché JP, Antoine JCG. Anti-AGO1 Antibodies Identify a Subset of Autoimmune Sensory Neuronopathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200105. [PMID: 37072227 PMCID: PMC10112859 DOI: 10.1212/nxi.0000000000200105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/27/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Autoantibodies (Abs) improve diagnosis and treatment decisions of idiopathic neurologic disorders. Recently, we identified Abs against Argonaute (AGO) proteins as potential autoimmunity biomarkers in neurologic disorders. In this study, we aim to reveal (1) the frequency of AGO1 Abs in sensory neuronopathy (SNN), (2) titers and IgG subclasses, and (3) their clinical pattern including response to treatment. METHODS This retrospective multicentric case/control study screened 132 patients with SNN, 301 with non-SNN neuropathies, 274 with autoimmune diseases (AIDs), and 116 healthy controls (HCs) for AGO1 Abs through ELISA. Seropositive cases were also tested for IgG subclasses, titers, and conformation specificity. RESULTS AGO1 Abs occurred in 44 patients, comprising significantly more of those with SNN (17/132 [12.9%]) than those with non-SNN neuropathies (11/301 [3.7%]; p = 0.001), those with AIDs (16/274 [5.8%]; p = 0.02), or HCs (0/116; p < 0.0001). Ab titers ranged from 1:100 to 1:100,000. IgG subclass was mainly IgG1, and 11/17 AGO1 Ab-positive SNN (65%) had a conformational epitope. AGO1 Ab-positive SNN was more severe than AGO1 Ab-negative SNN (e.g., SNN score: 12.2 vs 11.0, p = 0.004), and they more frequently and more efficiently responded to immunomodulatory treatments than AGO1 Ab-negative SNN (7/13 [54%] vs 6/37 [16%], p = 0.02). Regarding the type of treatments more precisely, this significant difference was confirmed for the use of IV immunoglobulins (IVIg) but not for steroids or second-line treatments. Multivariate logistic regression adjusted for potential confounders showed that AGO1 Ab positivity was the only predictor of response to treatment (OR 4.93, 1.10-22.24 95% CI, p = 0.03). DISCUSSION Although AGO Abs are not specific for SNN, based on our retrospective data, they may identify a subset of cases with SNN with more severe features and a possibly better response to IVIg. The significance of AGO1 Abs in clinical practice needs to be explored on a larger series.
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Affiliation(s)
- Christian P Moritz
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France.
| | - Yannick Tholance
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Pierre-Baptiste Vallayer
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Le-Duy Do
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Sergio Muñiz-Castrillo
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Veronique Rogemond
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Karine Ferraud
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Coralie La Marca
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Jerome Honnorat
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Martin Killian
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Stéphane Paul
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Jean-Philippe Camdessanché
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
| | - Jean-Christophe G Antoine
- From the Department of Neurology (C.P.M., P.-B.V., K.F., J.-P.C., J.-C.G.A.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (SynatAc) Team (C.P.M., Y.T., L.-D.D., S.M.-C., V.R., K.F., C.L.M., J.H., J.-P.C., J.-C.G.A.), Institut NeuroMyoGène, MELIS, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1; Faculty of Medicine (C.P.M., Y.T., J.-P.C., J.-C.G.A.), University Jean Monnet, Saint-Étienne, Saint-Priest-en-Jarez; Department of Biochemistry (Y.T., C.L.M.), University Hospital of Saint-Etienne; French Reference Center on Paraneoplastic Neurological Syndrome (L.-D.D., S.M.-C., V.R., J.H., J.-P.C., J.-C.G.A.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Department of Internal Medicine (M.K.), University Hospital of Saint-Etienne; CIRI-Centre International de Recherche en Infectiologie (M.K., S.P.), Team GIMAP (Saint-Etienne), Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM; CIC Inserm 1408 Vaccinology (M.K., S.P.), Saint-Etienne; Department of Immunology (S.P.), University Hospital of Saint-Etienne; and European Reference Center for Rare Neuromuscular Diseases (J.-P.C., J.-C.G.A.), Saint-Etienne Cedex 02, France
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Sokmen O, Temucin CM, Ayhan Seker C, Tan E. Immunotherapy Provides Electrophysiological Recovery and Excellent Clinical Response in Sjogren's Syndrome-Linked Quite Severe Autonomic Neuropathy. Neurologist 2023; 28:204-206. [PMID: 36223306 DOI: 10.1097/nrl.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The autonomic system is frequently affected in Sjogren's syndrome (SS), but presentation with severe autonomic neuropathy is infrequent. Herein, we present a patient with primary SS-linked autonomic neuropathy, which is significantly clinic and electrophysiological responsive to immunotherapy. CASE REPORT A 29-year-old female patient was admitted to our neurology department with recurrent syncope, postural light-headedness, and weight loss. Neurological examination revealed tonic pupils. The baseline composite autonomic symptom score-31 was 51 (0 to 75), and baseline functional ability score was 10 (0 to 100%). In the follow-up, syncope episodes that frequently develop during the day required the patient to lie in the supine position in bed all day and were triggered even by coming to a slightly sitting position. Neurophysiologic testing showed evidence of cardiovagal and sudomotor impairment. The patient was diagnosed with SS after detailed investigations. A 5-day course of intravenous immunoglobulin (IVIg) was given, and she continued IVIg once a month. After 6 months, she could walk long distances without support, and gastrointestinal complaints and syncopes had significantly decreased. After ~1.5 years, she had a composite autonomic symptom score-31 score of 11 and a functional ability score of 80%. Control heart rate variability analysis showed a significant improvement in the values of SD of the RR interval and root mean square of successive RR interval differences. CONCLUSIONS In SS-linked severe autonomic neuropathy, immunotherapy can provide electrophysiological recovery in addition to excellent clinical response.
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Affiliation(s)
| | | | - Cansu Ayhan Seker
- Department of Internal Medicine, Hacettepe University Hospital, Ankara,Turkey
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23
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De Souza JM, Trevisan TJ, Sepresse SR, Londe AC, França Júnior MC, Appenzeller S. Peripheral Neuropathy in Systemic Autoimmune Rheumatic Diseases-Diagnosis and Treatment. Pharmaceuticals (Basel) 2023; 16:ph16040587. [PMID: 37111344 PMCID: PMC10141986 DOI: 10.3390/ph16040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Peripheral neuropathy (PN) is frequently observed in systemic rheumatic diseases and is a challenge in clinical practice. We aimed to review the evidence on the subject and proposed a comprehensive approach to these patients, facilitating diagnosis and management. We searched the MEDLINE database for the terms (and its respective Medical Subject Headings (MeSH) terms): "peripheral neuropathy" AND "rheumatic diseases" OR "systemic lupus erythematosus", "rheumatoid arthritis", "Sjogren syndrome", and "vasculitis" from 2000 to 2023. This literature review focuses on the diagnostic workup of PNs related to systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, and systemic vasculitis. For every type of PN, we provide a pragmatic flowchart for diagnosis and also describe evidence-based strategies of treatment.
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Affiliation(s)
- Jean Marcos De Souza
- Department of Internal Medicine, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Thiago Junqueira Trevisan
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
| | - Samara Rosa Sepresse
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Ana Carolina Londe
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Post-Graduate Program in Physiopathology, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | | | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
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Nortey J, Shiboski C, Rose-Nussbaumer J, Bunya VY, Lietman T, Gonzales JA. How Are Sicca Signs and Symptoms Associated With Depression Among Men Classified With and Without Sjögren Disease? Am J Ophthalmol 2023; 247:96-102. [PMID: 36220352 DOI: 10.1016/j.ajo.2022.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Sjögren disease (SjD) cohorts represent rich resources to study associations between dry eye/mouth (sicca) signs/symptoms and depression. Because SjD affects mainly women, little is known about men with sicca signs/symptoms and associations with depression. The Sjögren's International Collaborative Clinical Alliance contained many men allowing for studying associations between sicca signs/symptoms and depression. We hypothesized that sicca symptoms would be positively associated with depression in males. DESIGN Cross-sectional study. METHODS At baseline, participants completed questionnaires and underwent ocular and oral examinations. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression models were used to identify associations between depression and SjD diagnostic criteria and sicca symptoms. RESULTS Of 309 males, 98 were classified as SjD, whereas 198 were classified as non-SjD. We found that having a labial salivary gland biopsy with focus score ≥1 foci/mm2 was associated with a lower odds of being classified as depressed (odds ratio [OR]: 0.36, 95% CI: 0.18-0.73, P = .01). Having positive anti-Sjögren syndrome antigen A antibody was associated with lower odds of being classified as depressed (OR: 0.44, 95% CI: 0.23-0.88, P = .02). Higher odds of depression were found with ocular burning (OR: 3.16, 95% CI: 1.74-5.73, P < .001), light sensitivity (OR: 2.59, 95% CI: 1.48-4.55, P = .001), and complaints of dry mouth (OR: 4.58, 95% CI: 1.54-13.63, P = .006). CONCLUSION Ophthalmologists should be specific when inquiring about ocular discomfort (focusing on burning and light sensitivity) and consider querying about depression and/or providing mental health resources to those who endorse such qualities.
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Affiliation(s)
- Jeremy Nortey
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina (J.N.), USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California (C.S.), USA
| | - Jennifer Rose-Nussbaumer
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA
| | - Vatinee Y Bunya
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (V.Y.B.), USA and
| | - Tom Lietman
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California (T.L., J.A.G.), USA
| | - John A Gonzales
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California (T.L., J.A.G.), USA.
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25
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Sjögren's syndrome with and without neurological involvement. J Neurol 2023; 270:2987-2996. [PMID: 36802030 DOI: 10.1007/s00415-023-11613-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Neurological manifestations of Sjögren's syndrome can be severe but also treatment-responsive. We aimed to systematically evaluate neurological manifestations of primary Sjögren's syndrome and find clinical features allowing sufficient identification of affected patients (pSSN) among those with Sjögren's syndrome without neurological involvement (pSS). METHODS Para-/clinical features of patients with primary Sjögren's syndrome (2016 ACR/EULAR classification criteria) were compared between pSSN and pSS. At our university-based center, patients with suggestive neurological symptoms undergo screening for Sjögren's syndrome, and newly diagnosed pSS patients are thoroughly evaluated for neurologic involvement. pSSN disease activity was rated by the Neurological Involvement of Sjögren's Syndrome Disease Activity Score (NISSDAI). RESULTS 512 patients treated for pSS/pSSN at our site between 04/2018 and 07/2022 were included (238 pSSN patients [46%] vs. 274 pSS patients [54%], cross-sectional design). Independent predictors of neurological involvement in Sjögren's syndrome were male sex [p < 0.001], older age at disease onset [p < 0.0001], hospitalization at first presentation [p < 0.001], lower IgG levels [p = 0.04] and higher eosinophil values (treatment-naïve) [p = 0.02]. Univariate regression additionally showed older age at diagnosis [p < 0.001], lower prevalence of rheumatoid factor [p = 0.001], SSA(Ro)/SSB(La) antibodies [p = 0.03; p < 0.001], higher white blood cell count [p = 0.02] and CK levels [p = 0.02] (treatment-naïve) in pSSN. INTERPRETATION Patients with pSSN had different clinical characteristics than patients with pSS and represented a large proportion of the cohort. Our data suggest that neurological involvement in Sjögren's syndrome has been underestimated. Intensified screening for neurologic involvement should be included in the diagnostic algorithm for Sjögren's syndrome, especially in males of older age and with severe disease course requiring hospitalization.
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Seeliger T, Dreyer HN, Siemer JM, Bönig L, Gingele S, Dohrn MF, Prenzler N, Ernst D, Witte T, Skripuletz T. Clinical and paraclinical features of small fiber neuropathy in Sjögren's syndrome. J Neurol 2023; 270:1004-1010. [PMID: 36331613 PMCID: PMC9886580 DOI: 10.1007/s00415-022-11431-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Sjögren's syndrome is a potentially treatable cause of Small Fiber Neuropathy (SFN)-a condition that severely affects patients' quality of life. We therefore aimed to characterize patients with SFN and Sjögren's syndrome to raise awareness of this disease and facilitate its early recognition as an essential step for appropriate treatment. In 97 SFN patients (median age 48 years, 77% female), we studied the clinical features associated with Sjögren's syndrome compared to the idiopathic SFN subtype. According to the current ACR/EULAR classification criteria (Shiboski et al., Ann Rheum Dis 76:9-16, 2017), 24/97 individuals (25%, median age 48.5 years, 75% female) were diagnosed with Sjögren's syndrome. We did not observe any differences in SFN-defining sensory plus symptoms. Furthermore, intraepidermal nerve fiber densities (IENFD) were significantly lower in patients with SFN and Sjögren's syndrome (mean 2.6 ± 1.2/mm) compared to patients with idiopathic SFN (mean 3.2 ± 1.5/mm; p = 0.048). There were no significant group differences when analyzing cerebrospinal fluid (CSF) parameters. We conclude that Sjögren's syndrome-associated SFN is difficult to distinguish from idiopathic forms based on initial clinical symptoms and CSF results. However, lower IENFD values in patients with Sjögren's syndrome-associated SFN might indicate a distinct different pathomechanism in this entity compared to idiopathic SFN.
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Affiliation(s)
- Tabea Seeliger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Henrike Neelke Dreyer
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Janna Margaretha Siemer
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Bönig
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Nils Prenzler
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Diana Ernst
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Comparison of cutaneous silent period parameters in patients with primary Sjögren's syndrome with the healthy population and determination of ıts relationship with clinical parameters. Rheumatol Int 2023; 43:355-362. [PMID: 36048188 DOI: 10.1007/s00296-022-05198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023]
Abstract
Small fiber neuropathy (SFN) is one of the main neurological manifestations in primary Sjögren's Syndrome (pSS). For the detection of SFN, cutaneous silent period (CSP) measurement is gaining popularity recently due to its non-invasiveness and practical application. Evaluating SFN involvement in patients with pSS using CSP and evaluating its relationship with clinical parameters. Patients with a diagnosis of pSS and healthy volunteers demographically homogeneous with the patient group were included in the study. The CSP responses were recorded over the abductor pollicis brevis muscle. The latency and duration values of the responses were obtained. In patient group, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36) questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Central Sensitization Inventory (CSI) were applied for the evaluation of symptom severity, mood, quality of life, presence of neuropathic pain and central sensitization, respectively. The mean CSP latency was significantly longer in patient group compared to control group (p < 0.001). Mean CSP duration was also significantly shorter in patient group (p < 0.001). There were no significant differences in CSP parameters according to patients' neuropathic pain or central sensitization profile. There were significant correlations of CSP parameters (latency and duration, respectively) with ESSPRI dryness (ρ = 0.469, p = 0.004; ρ = -0.553, p < 0.001), fatigue (ρ = 0.42, p = 0.011; ρ = -0.505, p = 0.002), pain (ρ = 0.428, p = 0.009; ρ = -0.57, p < 0.001) subscores and mean ESSPRI score (ρ = 0.631, p < 0.001; ρ = -0.749, p < 0.001). When SF-36 subscores and CSP parameters were investigated, a significant correlation was found only between "bodily pain" subscore and CSP duration (ρ = -0.395, p = 0.017). In HADS, LANSS and CSI evaluations, a significant correlation was found only between HADS anxiety score and the CSP duration (ρ = 0.364, p = 0.02). As indicated by CSP measurement, SFN is more prominent in patients with pSS than in the healthy population. It is important to investigate the presence of SFN because of its correlation with the leading symptoms in the clinical spectrum of pSS.
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Wu Z, Wang D, Chen L, Xianyu K, Yang H. Analysis of clinical features and risk factors of peripheral neuropathy in patients with primary Sjögren's syndrome. Eur J Med Res 2023; 28:54. [PMID: 36717930 PMCID: PMC9885688 DOI: 10.1186/s40001-023-01013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To observe the clinical features and efficacy of immunosuppressive therapy in patients with primary Sjögren's syndrome (PSS) combined with peripheral neuropathy (PN) syndrome and to explore the risk factors for PN in patients with PSS. METHODS Sixty consecutive patients with PSS admitted to the Department of Rheumatology and Immunology, Wuhan No. 1 Hospital, from January 2014 to June 2020 were analysed retrospectively. Patients were divided into a PN group (N = 15) and a non-PN group (N = 45). The clinical characteristics of the two groups were compared, and the independent risk factors for PN combined with PSS were analysed by multivariate logistic regression. The patients with PSS combined with PN were followed up to observe the effect of immunosuppressive therapy. RESULTS The patients with PN had a longer course of disease than those without PN (z = - 3.225, P = 0.001), and the incidence of Raynaud's phenomenon, anti-SSB antibody, rheumatoid factor and hyperglobulinaemia was higher (all P < 0.05) in patients with PN than in those without PN. Multivariate logistic regression analysis showed that hyperglobulinaemia, RF and anti-SSB antibodies were independent risk factors for PN with PSS (P < 0.05). Fourteen patients with PSS-PN were treated with immunosuppressants. The clinical symptoms of 10 patients were relieved, and mRS scores of 10 patients were decreased. CONCLUSION PN is a common complication in PSS patients. Patients with PSS combined with PN have a longer course of disease and a significantly higher percentage of Raynaud's phenomenon, positive anti-SSB antibody, positive RF and hyperglobulinaemia. Immunosuppressive therapy was effective for partial remission of PN with PSS.
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Affiliation(s)
- Zhihong Wu
- grid.33199.310000 0004 0368 7223Department of Rheumatology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Wang
- grid.33199.310000 0004 0368 7223Department of Cardiology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lirong Chen
- grid.33199.310000 0004 0368 7223Department of Rheumatology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaipu Xianyu
- grid.33199.310000 0004 0368 7223Department of Rheumatology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiqing Yang
- grid.33199.310000 0004 0368 7223Department of Rheumatology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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29
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Pacoureau L, Urbain F, Venditti L, Beaudonnet G, Cauquil C, Adam C, Goujard C, Lambotte O, Adams D, Labeyrie C, Noel N. [Peripheral neuropathies during systemic diseases: Part I (connective tissue diseases and granulomatosis)]. Rev Med Interne 2023; 44:164-173. [PMID: 36707257 DOI: 10.1016/j.revmed.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
Systemic diseases (connective disease, granulomatosis) may be associated with peripheral neuropathies. The diagnosis can be complex when the neuropathy is the presenting manifestation of the disease, requiring close collaboration between neurologists and internists. Conversely, when the systemic disease is already known, the main question remaining is its imputability in the neuropathy. Regardless of the situation, the positive diagnosis of neuropathy is based on a systematic and rigorous electro-clinical investigation, specifying the topography, the evolution and the mechanism of the nerve damage. Certain imaging examinations, such as nerve and/or plexus MRI, or other more invasive examinations (skin biopsy, neuromuscular biopsy) enable to specify the topography and the mechanism of the injury. The imputability of the neuropathy in the course of a known systemic disease is based mainly on its electro-clinical pattern, on which the alternatives diagnoses depend. In the case of an inaugural neuropathy, a set of arguments orients the diagnosis, including the underlying terrain (young subject), possible associated systemic manifestations (inflammatory arthralgias, polyadenopathy), results of first-line laboratory tests (lymphopenia, hyper-gammaglobulinemia, hypocomplementemia), autoantibodies (antinuclear, anti-native DNA, anti-SSA/B) and sometimes invasive examinations (neuromuscular biopsy).
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Affiliation(s)
- L Pacoureau
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - F Urbain
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - L Venditti
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de neurologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - G Beaudonnet
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de neurophysiologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - C Cauquil
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de neurologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - C Adam
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service d'anatomie pathologique et neuropathologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - C Goujard
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - O Lambotte
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - D Adams
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de neurologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - C Labeyrie
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de neurologie, Centre de référence des neuropathies périphériques rares (NNERF), groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - N Noel
- Université Paris-Saclay, Assistance publique-Hôpitaux de Paris, service de médecine interne et immunologie clinique, groupe hospitalier universitaire Paris-Saclay, hôpital Bicêtre, Le Kremlin-Bicêtre, France.
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Liampas A, Parperis K, Erotocritou MF, Nteveros A, Papadopoulou M, Moschovos C, Akil M, Coaccioli S, Hadjigeorgiou GM, Hadjivassiliou M, Zis P. Primary Sjögren syndrome-related peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2023; 30:255-265. [PMID: 36086910 PMCID: PMC10087501 DOI: 10.1111/ene.15555] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. METHODS A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. RESULTS The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. CONCLUSIONS PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.
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Affiliation(s)
- Andreas Liampas
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Egaleo, Greece
| | - Christos Moschovos
- Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Stefano Coaccioli
- European League Against Pain, Zurich, Switzerland.,Department of Internal Medicine, Perugia University, Perugia, Italy
| | - Georgios M Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Panagiotis Zis
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.,Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Sheffield, Sheffield, UK
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31
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Naum R, Gwathmey KG. Autoimmune polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:587-608. [PMID: 37562888 DOI: 10.1016/b978-0-323-98818-6.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The autoimmune peripheral neuropathies with prominent motor manifestations are a diverse collection of unusual peripheral neuropathies that are appreciated in vast clinical settings. This chapter highlights the most common immune-mediated, motor predominant neuropathies excluding acute, and chronic inflammatory demyelinating polyradiculoneuropathy (AIDP and CIDP, respectively). Other acquired demyelinating neuropathies such as distal CIDP and multifocal motor neuropathy will be covered. Additionally, the radiculoplexus neuropathies, resulting from microvasculitis-induced injury to nerve roots, plexuses, and nerves, including diabetic and nondiabetic lumbosacral radiculoplexus neuropathy and neuralgic amyotrophy (i.e., Parsonage-Turner syndrome), will be included. Finally, the motor predominant peripheral neuropathies encountered in association with rheumatological disease, particularly Sjögren's syndrome and rheumatoid arthritis, are covered. Early recognition of these distinct motor predominant autoimmune neuropathies and initiation of immunomodulatory and immunosuppressant treatment likely result in improved outcomes.
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Affiliation(s)
- Ryan Naum
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Graham Gwathmey
- Neuromuscular Division, Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
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Sjögren syndrome and RFC1-CANVAS sensory ganglionopathy: co-occurrence or misdiagnosis? J Neurol 2023; 270:460-465. [PMID: 36155842 DOI: 10.1007/s00415-022-11382-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS RFC1-CANVAS and primary Sjögren syndrome (pSS) are among the most frequent causes of sensory ganglionopathy (SG) and can present simultaneously in a given patient, sharing confounding signs and symptoms. We describe the clinical characteristics of patients with SG due to CANVAS who were suspected of having or had received a previous diagnosis of pSS. METHODS Patients with SG and a genetically confirmed RFC1-CANVAS followed in our centre were ascertained and their personal history of pSS was collected. RESULTS Among the 71 patients with CANVAS, six patients (all females) had been diagnosed with pSS by their clinicians. In these six patients, the mean age at onset of the SG was 61 years, four patients describing gait instability and positive sensory symptoms, one only gait instability and one only positive sensory symptoms. Five patients had a history of chronic cough; signs at examination included a cerebellar syndrome (n = 3), vestibulopathy (n = 2), pes cavus (n = 3) and dysautonomia (n = 2). On neurophysiological examination, SG was generally severe and symmetrical. All patients presented a sicca syndrome, but only four patients had a confirmed pSS as per 2016 ACR-EULAR classification criteria. Four patients were treated but did not respond to immunosuppressive therapy, one suffering from side effects. INTERPRETATION The suspicion or diagnosis of pSS in a patient with SG should not exclude RFC1 expansion analysis, as a CANVAS diagnosis may dissuade the clinician from initiating or continuing immunosuppressive therapy, especially in unconfirmed pSS patients. Importantly, a sicca syndrome may lead to pSS misdiagnosis.
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Perez C, de Leeuw R, Escala P F, Fuentealba R, Klasser GD. Numb chin syndrome: What all oral health care professionals should know. J Am Dent Assoc 2023; 154:79-93. [PMID: 35644699 DOI: 10.1016/j.adaj.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/15/2022] [Accepted: 03/17/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Numb chin syndrome (NCS) is a rare sensory neuropathy involving the mental nerve. Symptoms of NCS are often overlooked because of their apparent innocent nature; however, owing to the frequent association of NCS with malignancies, the opposite should be the rule. Oral health care professionals may be the first to encounter patients with NCS and should be aware of its clinical characteristics in an effort to decrease patient morbidity and mortality. TYPES OF STUDIES REVIEWED A search in PubMed (MEDLINE) and the Cochrane Library was performed using the terms numb chin syndrome, numb chin, mental neuropathy, mental nerve neuropathy, and malignant mental nerve neuropathy, yielding 2,374 studies. After inclusion and exclusion criteria were applied, 102 studies remained. Descriptive statistics were performed, analyzing the etiology responsible for NCS, characteristics of NCS including associated symptoms, unilateral or bilateral nature, and information on professionals visited and examinations requested to make a diagnosis. RESULTS NCS was associated with malignancy in 29% through 53% of the published cases. Twenty-eight percent of patients initially consulted an oral health care professional with the symptom of a numb chin. Patients more likely to have NCS were those from the ages of 61 through 70 years; 74% were unilateral; and the most common symptoms reported were numbness (100%), paresthesia (18%), and pain (17%). Forty-seven percent of the NCS cases were associated with a recurrent malignancy, and the most prevalent associated diagnoses were breast cancer (32%) and lymphoma and leukemia (24%). CONCLUSIONS Oral health care professionals should be aware of the characteristics of NCS as they may be the first health care providers consulted for these symptoms. PRACTICAL IMPLICATIONS A thorough medical and dental history as well as a complete cranial nerve screening should be performed on all patients, especially those with numbness, as this may prevent misdiagnosis and allow a timely referral and a substantial improvement of treatment course and prognosis.
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Módis LV, Aradi Z, Horváth IF, Bencze J, Papp T, Emri M, Berényi E, Bugán A, Szántó A. Central Nervous System Involvement in Primary Sjögren's Syndrome: Narrative Review of MRI Findings. Diagnostics (Basel) 2022; 13:diagnostics13010014. [PMID: 36611306 PMCID: PMC9818673 DOI: 10.3390/diagnostics13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Central nervous system (CNS) involvement is one of the numerous extraglandular manifestations of primary Sjögren's syndrome (pSS). Moreover, neurological complaints precede the sicca symptoms in 25-60% of the cases. We review the magnetic resonance imaging (MRI) lesions typical for pSS, involving the conventional examination, volumetric and morphometric studies, diffusion tensor imaging (DTI) and resting-state fMRI. The most common radiological lesions in pSS are white matter hyperintensities (WMH), scattered alterations hyperlucent on T2 and FLAIR sequences, typically located periventricularly and subcortically. Cortical atrophy and ventricular dilatation can also occur in pSS. Whilst these conditions are thought to be more common in pSS than healthy controls, DTI and resting-state fMRI alterations demonstrate evident microstructural changes in pSS. As pSS is often accompanied by cognitive symptoms, these MRI alterations are expectedly related to them. This relationship is not clearly delineated in conventional MRI studies, but DTI and resting-state fMRI examinations show more convincing correlations. In conclusion, the CNS manifestations of pSS do not follow a certain pattern. As the link between the MRI lesions and clinical manifestations is not well established, more studies involving larger populations should be performed to elucidate the correlations.
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Affiliation(s)
- László V. Módis
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-411-600 (ext. 55252)
| | - Zsófia Aradi
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - János Bencze
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Tamás Papp
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Ervin Berényi
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
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Fukami Y, Koike H, Katsuno M. Current perspectives on the diagnosis, assessment, and management of vasculitic neuropathy. Expert Rev Neurother 2022; 22:941-952. [PMID: 36609209 DOI: 10.1080/14737175.2022.2166831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Vasculitic neuropathy can present associated with both primary and secondary systemic vasculitis as a result from underlying diseases such as rheumatic diseases and infections, Moreover, confined vasculitis in the peripheral nervous system may be present. Thus, the diagnosis and management of vasculitic neuropathy require multidisciplinary approaches. AREAS COVERED Current views as well as relevant clinical research on the diagnosis, assessment, and management of vasculitic neuropathy are reviewed to suggest appropriate treatment strategies. We searched PubMed and Google Scholar for reports published between July 2017 and July 2022. EXPERT OPINION For the treatment of vasculitic neuropathy, determining the causative primary disease is important and often requires diagnosis by tissue biopsy. Due to the scarce research on the treatment of vasculitic neuropathy, treatment is empirically based on findings from studies of systemic vasculitides involving other organs, particularly antineutrophil cytoplasmic antibody-associated vasculitis. In addition to conventional glucocorticoids and immunosuppressive agents, complement-targeted therapy, anti-B-cell therapy, and disease-specific molecular targeted therapies have recently gained relevance. Future research is needed to develop new patient-specific therapeutic options.
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Affiliation(s)
- Yuki Fukami
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Konen FF, Seeliger T, Schwenkenbecher P, Gingele S, Jendretzky KF, Sühs KW, Ernst D, Witte T, Skripuletz T. Saliva Free Light Chains in Patients with Neuro-Sjögren. Biomedicines 2022; 10:biomedicines10102470. [PMID: 36289732 PMCID: PMC9599066 DOI: 10.3390/biomedicines10102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Sjögren’s syndrome (SS) is an autoimmune disease characterized by sicca symptoms and various extra-glandular manifestations. The diagnosis of SS requires sicca symptoms, anti-SSA(Ro)-antibody positivity, and/or pathological focus scores on a minor salivary gland biopsy. Previous studies have investigated different biomarkers in order to avoid invasive diagnostic procedures. It was found that kappa and lambda free light chains (KFLC and LFLC) in saliva are specific for SS. Methods: FLC concentrations in saliva and serum were determined in 130 patients—50 with SS and neurological involvement (Neuro-Sjögren) and 80 neurological controls. The EULAR SS disease activity index and patient reported index (ESSPRI) were determined in patients with SS. Results: Patients with SS revealed increased pain and decreased saliva production according to the ESSPRI and Saxon test, respectively, with increasing FLC concentrations in the saliva. No significant differences in serum and salivary protein concentrations were observed between patients with SS and controls. Conclusion: KFLC and LFLC concentrations in saliva are not suitable to distinguish patients with Neuro-Sjögren and neurological control subjects, thus a diagnostic biopsy is still required. The association of salivary KFLC and LFLC concentrations with saliva production and ESSPRI pain score suggests a complex relationship between dryness and pain in patients with SS.
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Affiliation(s)
- Franz Felix Konen
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tabea Seeliger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Philipp Schwenkenbecher
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | | | - Kurt-Wolfram Sühs
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Diana Ernst
- Department of Immunology & Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Torsten Witte
- Department of Immunology & Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-3120
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37
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Antoine JC. Sensory neuronopathies, diagnostic criteria and causes. Curr Opin Neurol 2022; 35:553-561. [PMID: 35950727 DOI: 10.1097/wco.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To stress on the diagnostic strategy of sensory neuronopathies (SNN), including new genes and antibodies. RECENT FINDING SNN involve paraneoplastic, dysimmune, toxic, viral and genetic mechanisms. About one-third remains idiopathic. Recently, new antibodies and genes have reduced this proportion. Anti-FGFR3 and anti-AGO antibodies are not specific of SNN, although SNN is predominant and may occur with systemic autoimmune diseases. These antibodies are the only marker of an underlying dysimmune context in two-thirds (anti-FGFR3 antibodies) and one-third of the cases (anti-AGO antibodies), respectively. Patients with anti-AGO antibodies may improve with treatment, which is less clear with anti-FGFR3 antibodies. A biallelic expansion in the RFC1 gene is responsible for the cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) in which SNN is a predominant manifestation. Most of the patients have an adult onset and are sporadic. The RFC1 mutation may represent one-third of idiopathic sensory neuropathies. Finally, the criteria for the diagnosis of paraneoplastic SNN have recently been updated. SUMMARY The diagnostic of SNN relies on criteria distinguishing SNN from other neuropathies. The strategy in search of their cause now needs to include these recent findings.
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Affiliation(s)
- Jean-Christophe Antoine
- University Hospital of Saint-Etienne, European Reference Network for Rare Diseases- Euro-NMD, INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, Lyon, France
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Błochowiak K. Smell and Taste Function and Their Disturbances in Sjögren's Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12472. [PMID: 36231772 PMCID: PMC9564460 DOI: 10.3390/ijerph191912472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Chemosensory disorders are a possible disturbance in Sjögren's syndrome (SS). The aim of the study is to comprehensively present chemosensory disorders in SS and to indicate their possible causes. The possible causes of taste and smell disorders in SS are changes in the structure of exocrine glands and their dysfunction, damage to receptors and weakening of their ability to regenerate, and neurological changes in the form of peripheral neuropathy and impaired cognitive function. Other postulated causes of chemosensory disorders are autoimmune mechanisms, adverse effects of drugs used in SS, and primary potentially SS-triggering viral infections. They are multifactorial and may occur independently of each other. The time of their onset and correlation with other disease symptoms may facilitate the determination of their primary cause in each patient. Awareness of chemosensory disorders in SS may help to ease their progress and eliminate other factors responsible for their more severe manifestation. In the prevention and treatment of chemosensory disorders in SS, the most important thing is to alleviate xerostomia and dryness in the nasal cavity and their effects in the form of chronic local inflammations, counteract receptor atrophy, and an implementation of appropriate neurological diagnosis and treatment.
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Affiliation(s)
- Katarzyna Błochowiak
- Department of Oral Surgery and Periodontology, Poznan University of Medical Sciences, 61-812 Poznan, Poland
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Facial Onset Sensory and Motor Neuronopathy-Like Syndrome: A Case Report. J Clin Neuromuscul Dis 2022; 24:55-58. [PMID: 36005474 DOI: 10.1097/cnd.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Facial onset sensory and motor neuronopathy syndrome (FOSMN) is a rare motor neuron disorder characterized by facial sensory and motor aberrations that progress to the upper limbs. We present a case of FOSMN-like syndrome that has characteristics of FOSMN but is confined to the craniofacial region. METHODS Retrospective chart review and review of the literature. RESULTS A 70-year-old woman presented with a 1-month history of progressive bilateral facial sensory loss and weakness affecting the trigeminal and hypoglossal nerves. Within 12 months, she developed debilitating weakness affecting her lower and midface bilaterally. After an extensive workup, a diagnosis of FOSMN-like syndrome was made, as symptoms failed to progress to the upper extremities. CONCLUSIONS This case demonstrates a unique presentation of FOSMN that we classify as FOSMN-like syndrome. Clinicians must maintain a high index of suspicion when a patient presents with clinical features characteristic of FOSMN syndrome without progression of symptoms distal to the craniofacial region because it may represent a FOSMN-like syndrome.
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Appenzeller S, Andrade de Oliveira S, Bombini MF, Sepresse SR, Reis F, Cavalcante França Junior M. Neuropsychiatric manifestations in primary Sjogren syndrome. Expert Rev Clin Immunol 2022; 18:1071-1081. [PMID: 36001085 DOI: 10.1080/1744666x.2022.2117159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Neurologic manifestations in primary Sjogren´s Syndrome (pSS) are characterized by a heterogeneity of clinical manifestations. In clinical practice, physicians are challenged with the absence of diagnostic criteria and the lack of clinical trials to support treatment. In this article, we will review epidemiology, clinical and immunological characterization, diagnosis and treatment of neurologic events in pSS. AREAS COVERED This narrative review provides an overview of neurologic manifestations described in pSS, complementary investigations and treatment reported. Articles were selected from Pubmed searches conducted between December 2021 and February 2022. EXPERT OPINION Epidemiology and clinical features of neurologic manifestations are derived from different cohort studies. Our understanding of pathophysiology of neurologic manifestations in pSS has significantly increased in the past few years, especially regarding PNS. However, there are still many knowledge gaps on therapeutics. The few available data on therapy rely upon small case series, from experiences with other autoimmune disease, such as systemic lupus erythematosus or expert opinion. There is an urgent need for well-designed clinical trials.
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Affiliation(s)
- Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas
| | | | | | | | - Fabiano Reis
- Department of Radiology, School of Medical Science, University of Campinas
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Wada S, Hirano H, Uehara N, Kurotobi Y, Tsuzaki K, Takamatsu N, Fujita M, Hamano T. Cervical Root Enlargement in Segmental Zoster Paresis: A Study with Magnetic Resonance Imaging and Nerve Ultrasound. Intern Med 2022; 61:2361-2365. [PMID: 35022345 PMCID: PMC9424074 DOI: 10.2169/internalmedicine.8538-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.
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Affiliation(s)
- Shinichi Wada
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Hirohisa Hirano
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Naoko Uehara
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Yuri Kurotobi
- Department of Neurology, Kansai Electric Power Hospital, Japan
| | - Koji Tsuzaki
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | | | - Masaaki Fujita
- Department of Clinical Immunology and Rheumatology, Kansai Electric Power Hospital, Japan
| | - Toshiaki Hamano
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
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Wendebourg MJ, Kuhle J, Hardmeier M. Case Report: A 72-Year-Old Woman With Progressive Motor Weakness, Dry Eyes and High Levels of Serum Neurofilament Light Chain. Front Neurol 2022; 13:889894. [PMID: 35899270 PMCID: PMC9309382 DOI: 10.3389/fneur.2022.889894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDiagnosis of Amyotrophic Lateral Sclerosis (ALS) is challenging as initial presentations are various and diagnostic biomarkers are lacking. The diagnosis relies on the presence of both upper and lower motor neuron signs and thorough exclusion of differential diagnoses, particularly as receiving an ALS diagnosis has major implications for the patient. Sjögren's syndrome may mimic peripheral ALS phenotypes and should be considered in the work-up.CaseA 72-year-old female presented with a mono-neuropathy of the right leg and a complaint of dry eyes and mouth. Initial diagnostic work-up confirmed a regional sensorimotor neuropathy and a Sjögren's syndrome; a causal relationship was assumed. However, motor symptoms spread progressively despite immunosuppressive treatment, eventually including both legs, both arms and the diaphragm. Clinically, unequivocal central signs were lacking, but further along in the disease course, the atrophy pattern followed a split phenotype and deep tendon reflexes were preserved. Nerve biopsy did not show vasculitic infiltration; however, serum neurofilament light chain (sNfL) concentrations were and remained persistently highly elevated despite immunosuppressive treatment. Electrodiagnostic re-evaluation confirmed denervation in 3 regions. A diagnosis of familial ALS was finally confirmed by a C9orf 72 repeat expansion. Stationary sensory symptoms were best explained by a neuropathy associated with concomitant Sjögren's syndromeDiscussionOur instructive case shows the difficulties of diagnosing ALS in the setting of a peripheral symptom onset and a concurrent but unrelated condition also causing neuropathy. Such cases require high clinical vigilance and readiness to reappraise diagnostic findings if the disease course deviates from expectation. Recently proposed simplified diagnostic criteria, genetic testing and body fluid biomarkers such as sNfL may facilitate the diagnostic process and lead to an earlier diagnosis of ALS.
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Affiliation(s)
- Maria Janina Wendebourg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martin Hardmeier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- *Correspondence: Martin Hardmeier
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Ghislain B, Rabinstein AA, Braksick SA. Etiologies and Utility of Diagnostic Tests in Trigeminal Neuropathy. Mayo Clin Proc 2022; 97:1318-1325. [PMID: 35787858 DOI: 10.1016/j.mayocp.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/06/2021] [Accepted: 01/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the utility of diagnostic studies in identifying treatable etiologies of trigeminal neuropathy (TNP). PATIENTS AND METHODS We performed a review of consecutive patients with nontraumatic, noniatrogenic TNP seen at Mayo Clinic between January 1, 2000, and August 31, 2019. Patients were excluded if they had trigeminal neuralgia without neuropathy or if their diagnostic work-up had been completed elsewhere. Data were analyzed to determine which diagnostic studies were most useful in identifying treatable etiologies. RESULTS In total, 439 patients were included. The mean ± SD age was 56.3±13.6 years and 285 (64.9%) were female. Among the 180 cases in which an etiology was identified (41.0%), neoplasms were causative in 76 (42.2%), while specific connective tissue diseases were implicated in 71 (39.4%). Bilateral TNP (n=83) was associated with the presence of underlying connective tissue disease (P<.01). Identification of etiology was made by magnetic resonance imaging in 88 cases (48.8%), by abnormal connective tissue disease cascades combined with rheumatology consultation in 42 (23.3%), by a previously known connective tissue disorder in 30 (16.7%), and by abnormal connective tissue disease cascades alone in 8 (4.4%). Among the 439 study patients, electromyography was performed in 211 (48.1%) and lumbar puncture in 139 (31.7%), but their diagnostic utility was low. CONCLUSION Underlying causes of nontraumatic, noniatrogenic TNP can be identified in approximately 40% of cases. Bilateral TNP is strongly associated with underlying connective tissue disease. Careful history taking, dedicated magnetic resonance imaging, and connective tissue panels have the greatest diagnostic utility. Electromyography and cerebrospinal fluid analysis are unlikely to elucidate treatable etiologies of TNP.
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S B, Naidu G, Sharma A, Minz RW, Gupta A, Baishya J. Peripheral nervous system involvement in Sjogren's syndrome and its impact on quality of life. Clin Exp Med 2022; 23:539-545. [PMID: 35666344 DOI: 10.1007/s10238-022-00837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
Sjogren's syndrome (SS) is a multisystem disorder of autoimmune etiology, which can be primary or secondary. Quality of life in SS depends on severity of involvement of different systems. The aims of this study are to analyze peripheral nervous system involvement in primary and secondary SS and its impact on quality of life (QOL). In this cross-sectional observational study conducted between January 2020 and June 2021, 67 patients of SS attending to this tertiary care center were included. Nerve conduction study and sympathetic skin response test were done in all cases. QOL was assessed with SF-36 questionnaire. Out of 67 cases, 50 had primary and 17 had secondary SS. 50.7% of cases had peripheral neuropathy. In primary SS, prevalence of peripheral neuropathy was 56% as against 35.3% in secondary. 50% of peripheral neuropathy were asymptomatic and were diagnosed after electrodiagnostic tests. Polyneuropathy was the most common pattern. There was no difference of other system involvement or immunological markers among those with and without peripheral neuropathy in either primary or secondary SS. Cases with peripheral neuropathy in the primary Sjogren's group and in the cohort as a whole scored significantly lower in 7 domains of SF-36. Peripheral nervous system involvement is common in Sjogren's syndrome, and most of them are asymptomatic. Peripheral neuropathy has significant impact on QOL in people with SS. Early detection and halting the progression of asymptomatic cases can be helpful in improving QOL.
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Affiliation(s)
- Balaraja S
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gsrsnk Naidu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitupam Baishya
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Chaaban N, Shaver T, Kshatriya S. Sjogren Syndrome-Associated Autonomic Neuropathy. Cureus 2022; 14:e25563. [PMID: 35784971 PMCID: PMC9248235 DOI: 10.7759/cureus.25563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
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Haj Mohamad Ebrahim Ketabforoush A, Abbasi Khoshsirat N, Maghoul A, Nirouei M, Dolatshahi E. Acute polyneuropathy as the main manifestation of primary Sjogren’s syndrome: A case report. Clin Case Rep 2022; 10:e05828. [PMID: 35582167 PMCID: PMC9083809 DOI: 10.1002/ccr3.5828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022] Open
Abstract
Sjogren's syndrome is an inflammatory disease affecting many systems. We report a Sjogren case with the presenting feature of an acute motor‐predominant polyneuropathy resembling Guillain–Barre syndrome. Upon further investigation, it was found that the patient had sicca symptoms for months. Scrupulous history should be taken to prevent a missed diagnosis.
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Affiliation(s)
| | - Nahid Abbasi Khoshsirat
- Clinical Research Development Unit Shahid Rajaei Educational & Medical Center Alborz University of Medical Sciences Karaj Iran
| | - Arman Maghoul
- Student Research Committee Alborz University of Medical Sciences Karaj Iran
| | - Matineh Nirouei
- Student Research Committee Alborz University of Medical Sciences Karaj Iran
| | - Elahe Dolatshahi
- Clinical Research Development Unit Shahid Rajaei Educational & Medical Center Alborz University of Medical Sciences Karaj Iran
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Neuropatie sensitive. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Gibbons CH, Silvestri NJ. Autonomic Dysfunction in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Farran MZ, Kesserwani H. A Case of Sjögren's Syndrome Associated With Trigeminal Neuropathy and Enhancement of the Mandibular Nerve at the Foramen Ovale: A Case Report and a Review of the Differential Diagnosis and Mechanisms of the Disease. Cureus 2021; 13:e19463. [PMID: 34912606 PMCID: PMC8665627 DOI: 10.7759/cureus.19463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
We describe a case of Sjögren's syndrome-associated trigeminal neuropathy with mandibular nerve enhancement at the foramen ovale and Gasserian ganglion (Meckel's cave) in a patient with a prior history of breast cancer. We also explore the differential diagnosis of trigeminal neuropathy associated with mandibular nerve involvement at the foramen ovale and exclude other diseases such as Sjögren's syndrome or perineurial invasion as a result of various carcinomas. We emphasize the importance of an investigative triad of searching for a local head-and-neck malignancy that may metastasize by perineural spread or invasion, excluding a distant malignancy or paraneoplastic phenomenon and ruling out an autoimmune etiology such as Sjögren's syndrome. In the process, we briefly outline the basic immunopathologic processes.
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Chen C, Wang S, Zhang G, Li X. Uveal Effusion Syndrome as the Initial Manifestation of Primary Sjögren's Syndrome and Review of the Literature. Ocul Immunol Inflamm 2021; 29:1348-1354. [PMID: 32749912 DOI: 10.1080/09273948.2020.1748202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: The authors report a38-year-old woman with primary Sjögren's syndrome who initially showed recurrent blurred vision caused by uveal effusion syndrome and later developed dry mouth, dry eyes, and arthralgia. During the 5-year-course of disease, the patient's 3-time-onset was all manifested as blurred vision after decreased immunity. Despite the initial absence of sufficient immunological evidence, the final presence of positive serum anti-SS-A, rheumatoid factors, ANA, and inflammatory findings in minor salivary gland biopsy indicated primary Sjögren's syndrome.Methods: Retrospective review of a case note.Conclusions: The manifestation of UES requires further exploration of its real pathogenesis, and the possibility of systemic disease should never be excluded.
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Affiliation(s)
- Chunli Chen
- Department of Ophthalmology, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.,Department of Ophthalmology, Shengli Oilfield Central Hospital, Shandong, China
| | - Shuya Wang
- Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Ophthalmology, Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Ophthalmology, Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases in Universities of Shandong, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guanhong Zhang
- Department of Ophthalmology, Shengli Oilfield Central Hospital, Shandong, China
| | - Xiaorong Li
- Department of Ophthalmology, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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