Tharshannia, Balaikerisnan (2017) Prevalence and associated features of peripheral neuropathy in a cohort of Malaysian systemic sclerosis patients in UMMC / Tharshannia Balaikerisnan. Masters thesis, University of Malaya.
Abstract
Peripheral neuropathy in systemic sclerosis (SSc) is an under recognized clinical feature of unknown prevalence. Commonly this group of patients complains of distal paresthesia. The etiology of peripheral neuropath) is unclear with various pathomechanisms being postulated to cause peripheral neuropathy ranging from vasculopathy affecting the vasa nevorum, direct compression damage due to edema and fibrosis and anti-neuronal antibodies against the nervous system. OBJECTIVE The aim of this study is to determine the prevalence of PN in SSc patients and to identify the associated factors such as clinical features, disease markers, comorbidities and medications. METHODOLOGY All SSc patients seen at the University of Malaya Medical Centre were included. Demographic, clinical and laboratory data were obtained from medical records. Skin tightness was assessed using the Modified Rodnan Skin Scoring tool (MRSS). Clinical symptoms of peripheral neuropathy was assessed using the modified Total Neuropathy Score (TNS). Nerve conduction studies (NCS) were carried out on the upper and lower limbs. Neuropathy was defined as abnormal TNS (score of ~ 2) together with abnormal NCS. A diagnosis of symmetrical polyneuropathy was made if there were abnormal NCS parameters in at least 2 nerves including the sural, while focal neuropathy was defined as abnormal NCS of a nerve other than the sural nerve (radial, median, ulnar, common peroneal). Associated SSc features such as severity of skin fibrosis, presence of vasculitis and raynaud's were assesed in all patients. RESULTS A total of82 SSc subjects were identified and 54 enrolled, of the 54 subjects, the majority were females (50, 90.9%). Most were from the limited cutaneous subset (43.78.6%) while I I (21.4%) were from diffuse cutaneous subset. Mean age was 56.18 (SO± 12.3) years. Mean duration of disease (non-Raynaud"s disease onset) was 9.6 years (SO ± 8.18) (range of I year to 44 years) years. Out of 54 patients. 34 (62.9%) had Total Neuropathy Score (TNS) of ~ 2. On NCS, 17 (31.5%) patients and 12 (22.2%) had findings of symmetrical polyneuropathy and focal neuropathy respectively. A total of 14 (25.9%) SSc patients were diagnosed to have symmetrical polyneuropathy (combined TNS ~ 2 and symmetrical polyneuropathy). There was no correlation seen in SSc related disease markers such as skin fibrosis, Raynaud"s or vaseulopathy and SSc specific autoantibodies. CONCLUSION The prevalence of peripheral neuropathy in our Malaysian SSe cohort is similar to other studies. There were no significant associations with disease markers suggesting polyneuropathy may be due to non-disease conditions.
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