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Journal of The Association of Physicians of India ■ Vol. 63 ■ December 2015
15
Original Article
Peripheral Neuropathy in Systemic Lupus Erythematosus: Clinical and Electrophysiological Properties and their Association with Disease Activity Parameters Renu Saigal1, Rajat Bhargav2, Laxmikant Goyal3, Abhishek Agrawal4, RN Yadav4, Pradeep Mital 5, Dileep Wadhwani6
Abstract
Editorial Viewpoint
Aim: To study clinical and electrophysiological properties of peripheral neuropathy (PN) in systemic lupus erythematosus (SLE) and their association with disease activity parameters.
• Neuropathy in SLE is not uncommon.
Methods: A hospital-based observational study done among 50 SLE patients after informed consent. History and clinical examination including a detailed neurological examination was carried out. Blood and urine investigation were done and modified SLE disease activity index (SLEDAI)-2000 score was calculated. Results: PN was found in 18 out of 50 (36%) SLE cases as defined electrophysiologically, nine had clinical and nine had subclinical neuropathy. On nerve conduction studies (NCS) 17 patients had axonal pattern. There were significant difference for mean ESR in patients with neuropathy (64.17 ± 42.43 mm/1 st hour) and without neuropathy (42.34 ± 27.68 mm/1st hour) (P 0.033) and for mean modified SLEDAI-2000 of patients with neuropathy (15.61 ± 10.09) and without neuropathy (6.84 ± 6.16) (P 500 mg/24 hours, hematuria (≥5 erythrocytes/high power field), pyuria (≥5 leukocytes/ high power field) or heme-granular a n d r e d b l o o d c e l l c a s t s we r e present and other causes causing such picture like stone, calculus, and infection excluded. PN was defined electrophysiologically. NCS were carried out on the day of clinical visit in every patient on a 4-channel Nicolet EA-4 machine by a person who was blinded to the clinical status of the patients. Surface stimulating and recording electrodes were used. The following nerves were studied bilaterally – median (motor and sensory), ulnar (motor and sensory), peroneal (motor ), tibial (motor ) and sural (sensory). F waves (median latency) of median, ulnar, peroneal and tibial nerves were also measured bilaterally. An abnormal value was defined as ± 2.5 standard deviation above or below the laboratory’s normal mean. SLE disease activity was assessed for each case of SLE using the Modified SLE Disease Activity Index – 2000.14-15 In modified SLE Disease Activity Index – 2000, disease activity is assessed without the serological parameters i.e. antidsDNA and serum complement. This index has good discriminative validity and low cost. 14,15 Statistical Analysis
Microsoft Excel ® and SPSS ® 17.0 for Windows ® were used for data storage and analysis. Continuous variables were expressed as mean ± standard deviation. Unpaired Student’s t test and chi-square test were used to determine statistical d i f f e r e n c e b e t we e n va r i a b l e s . Pearson’s coefficient was used t o i n ve s t i g a t e t h e c o r r e l a t i o n between two variables. Statistical significance was set at P value ≤ 0.05.
Results The study population included 50 patients of SLE (46 females and 4 males) with mean age 27.4 ± 10.45 years (range 8-54 years), mean duration of disease 32.6 ± 40.33 months (range 2-180 months), mean age at onset of disease 24.68 ± 09.94 years and modified SLEDAI-2000 score 10.0 ± 8.79 (Table 1). Eighteen SLE patients out of fifty had electrophysiologically defined PN. Nine patients had clinically evident neuropathy. Out of these nine patients, one patient had only diminished deep tendon reflexes in lower limbs and eight patients had varied intensity of diminished perception to touch, pain, temperature and vibration in distal parts with varied degree of motor weakness in distal muscles o f u p p e r a n d / o r l o we r l i m b s . Another group of nine patients had electrophysiologically defined PN without clinically evident signs/ symptoms. Thus, nine patients had clinical and nine patients had subclinical neuropathy, diagnosed by NCS (Table 2). Duration of disease and duration o f t r e a t m e n t we r e s h o r t e r f o r patients with PN but the difference was not statistically significant (P >0.05) (Table 3). ESR and modified SLEDAI2000 were significantly higher in patient with peripheral neuropathy compared to patients without neuropathy, showing association of PN with active SLE disease (P
