The Clinical Features of Painful Small-Fiber Neuropathy Suggesting an Origin Linked to Primary Sjogren's Syndrome

Objective We attempted to determine whether clinical features could differentiate painful small-fiber neuropathy related to primary Sjeuroogren's syndrome (pSS-SFN) from idiopathic SFN (idio-SFN). Methods Validated clinical questionnaires and neurophysiological investigations specific for pain and SFN assessment were performed in 25 patients with pSS-SFN and 25 patients with idio-SFN. Results Patients with idio-SFN had more frequent severe burning sensations and higher mean anxiety scores and daily pain intensity compared to patients with pSSSFN. Conversely, patients with pSS-SFN had reduced electrochemical skin conductance measured by Sudoscan_, and almost half of them had the sensation of walking on cotton wool. Conclusion Our results suggest that idio-SFN more specifically involved small sensory fibers than pSS-SFN, in which subtle dysfunction of larger sensory fibers and damage of distal autonomic sudomotor innervation may occur. A practical algorithm is proposed to help to differentiate SFN associated with pSS from idio-SFN, based on information very easy to obtain by clinical interview.