Neuropathy means inflammation and/or damage to the peripheral nerves. There are many causes of neuropathy including autoimmune conditions and that is why it can affect patients with Sjögren’s syndrome.
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| Neurons are the fundamental units of the brain and nervous system, the cells responsible for receiving sensory input from the external world, for sending motor commands to our muscles,and for transforming and relaying the electrical signals at every step in between. UNIVERSITY OF QUEENSLAND |
The symptoms of neuropathy include sensations that are described as numbness, tingling, burning, freezing, and hypersensitivity. Neuropathy is usually felt in the fingers, hands, toes and feet but can be felt in many other parts of the body including the tip of the nose.
It is usually a neurologist who determines the “pattern” of neuropathy (i.e. mononeuritis multiplex versus small-fiber neuropathy).
Distinguishing between these patterns is of paramount importance, because of different therapeutic strategies.
The pain of neuropathy can be especially severe and may require different analgesics and anti-seizure medications. However, symptomatic treatment of pain should not preclude medications to dampen the immune-system, when there is evidence of ongoing neuroinflammation.
Neuroinflammation is defined as an inflammatory response within the brain or spinal cord.
From Johns Hopkins Sjögren’s Center
Shamik Bhattacharyya, MD, MS, assistant professor of neurology at Brigham and Women’s Hospital, Boston, discussed the various forms of neuropathy that can arise in patients with confirmed Sjögren’s syndrome.
Dr. Bhattacharyya noted that, in 25–60% of cases, neurologic symptoms precede a diagnosis of Sjögren’s syndrome by months or even years. When they do occur, such symptoms can manifest as cranial neuropathy, ganglionopathy, axonal polyneuropathy, multiple mononeuropathy and autonomic neuropathy. As you can see there are many different kinds of neuropathy.
When a neuropathy is identified, clinicians must consider other causes, such as diabetes or vitamin deficiencies, in the differential before assuming the neuropathy is related to Sjögren’s syndrome. This is often easier said than done because no specific biomarker identifies a neuropathy as related to Sjögren’s. Age can also serve as a confounder because older adults are more likely than younger individuals to develop Sjögren’s syndrome and are more likely to manifest neuropathies in general.
Dr. Bhattacharyya has made it his practice to discuss and manage the expectations of patients early in the therapeutic encounter. Often, he has patients return six weeks after the initial consultation and, if the neuropathy is progressing, he considers a trial of a steroid pulse treatment and extended steroid taper, with the goal of slowing the neuropathy’s progression.
Goals of treatment for neuropathy include:
- Finding the cause
- Controlling the symptoms
- Promoting a person's self-care and independence
Depending on the cause, treatment may include:
- Changing medicines, if they are causing the problem
- Controlling blood sugar level, when the neuropathy is from diabetes
- Not drinking alcohol
- Taking daily nutritional supplements
- Medicines to treat the underlying cause of the polyneuropathy
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