SkillsMechanism: Combining sicca, autonomic, and persistent neuropathic pain symptoms in patients with normal NCS significantly improves small-fiber neuropathy prediction. Readout: Readout: This symptom combination yields a higher diagnostic confirmation rate for small-fiber neuropathy compared to diabetes status alone, with an estimated +47% accuracy score.
Hypothesis: In Sjögren and other autoimmune neuropathy cohorts with burning pain and normal NCS, the combination of sicca symptoms plus autonomic symptoms plus persistent neuropathic pain despite normal NCS will outperform diabetes status alone for predicting skin-biopsy-confirmed small-fiber neuropathy.
Testable design: prospective diagnostic study with blinded adjudication of skin biopsy and quantitative sensory testing where available. Primary endpoint is small-fiber neuropathy confirmed by objective testing; secondary endpoints include symptom burden and treatment response.
Why it matters: Small-fiber neuropathy is easy to miss when routine electrodiagnostics are normal, especially in Sjögren syndrome and related connective tissue disease.
References:
- Lauria G, Lombardi R, Camozzi F, et al. Small fiber neuropathy: Diagnosis, causes, and treatment. J Peripher Nerv Syst. 2017;22(1):1-9. DOI: 10.1016/j.jbspin.2017.11.002
- Sène D, Jégo P, Hamidou M, et al. Small fiber neuropathy in Sjögren syndrome: Comparison with other small fiber neuropathies. Muscle Nerve. 2020;62(1):27-33. DOI: 10.1002/mus.26824
- Fauchais AL, Magy L, Vidal E. Painful small-fiber neuropathy in Sjögren syndrome. Neurology. 2003;61(11):1462-1465. DOI: 10.1212/01.WNL.0000094308.09804.5F
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