Small fiber neuropathy and autoimmune diseases

Abstract

Small fiber neuropathy can be described as a dysfunction of the nerve fibers of the smallest diameter (A delta and C types), which are widely present in the skin, mucous membranes and internal organs. Among the causes of small fiber neuropathy various autoimmune and immune-mediated diseases have been recognized, including Sjogren’s syndrome, celiac disease, systemic lupus erythematosus, fibromyalgia, diabetes mellitus type I and sarcoidosis. This article addresses clinical features, diagnostic methods and treatment options of small fiber neuropathy. Sensory symptoms and autonomic dysfunction are the most common clinical manifestations. There are several validated questionnaires for the small fiber neuropathy, but the “gold standard” for the diagnosis is a skin biopsy followed by an immunofluorescence or immunohistochemical analysis to assess the density of small nerve fibers in the epidermis of the skin. Besides symptomatic treatment, pathogenetic therapy of autoimmune/inflammatory subtype of small fiber neuropathy should be considered.

Keywords:

autoimmune diseases, small fiber neuropathy, allodynia, paresthesia, pain, dysautonomia, postural orthostatic tachycardia syndrome, pain management