Sistemik Skleroz Hastalarında Dijital Ülser Oluşumu ve Küçük Lif Nöropatisi İlişkisinin Değerlendirilmesi

Abstract

Neuropathy is a common feature of collagen tissue disorders. Quantitative sensory testing (QST) is a non-invasive method that has been used to detect and characterize neuropathies. The aim of this study is to evaluate the patients with systemic sclerosis (SSc) by using QST for the presence of small and large fiber neuropathies and to investigate the association between digital ulcers and neuropathy. QST was performed in all subjects by using CASE IV machine (WR Medical Electronics, Stillwater, Minnesota). Every subject was also evaluated with neurologic examination, Michigan Neuropathy Screening Instrument (MNSI) and Small Fiber Neuropathy Symptoms Inventory Questionnaire (SFN-SIQ). Fifthy SSc patients were enrolled. The mean age of the patients was 47 ± 12 and the mean disease duration was 11.3 ± 7.2 years. Sixty-six percent (33) of the patients had a history of digital ulcer and / or pitting scar, 42% (21) of the patients had an abnormal finding during neurologic examination. Twenty percent (10) of the patients had MNSI questionnaire score ≥ 4 and the median SFN-SIQ score of the patients was 8 (minimum-maximum 0-22). In QST evaluation, 84% (42) of patients had abnormal vibration and / or cold detection thresholds. The abnormal vibration-detection thresholds were found in 80% (40) and abnormal cold-detection threshold was found in 20% (10) of the patients. The number of patients with upper extremity vibration detection threshold abnormality was higher than the patients with lower extremity abnormality. However, the difference was not statistically significant (p > 0.05). There was no statistically significant difference between the groups with and without QST abnormalities regarding to the other clinical features including digital ulcer history (p NS for all). In conclusion, we detected a significant number of SSc patients with QST abnormality, especially with abnormal vibration detection thresholds in this study. To determine the clinical importance of QST in SSc patients; longitudinal studies in early SSc patients are needed.