Background/Purpose: We performed bedside testing for peripheral neuropathy in our Systemic Sclerosis (SSc) population to determine whether foot care guidelines should be developed for SSc.  

Methods: Twenty consecutive SSc patients and 20 healthy control patients were evaluated for peripheral neuropathy in both feet using the 10-g Semmes-Weinstein monofilament examination [SWME] three times on four sites bilaterally and vibration sensation using the on-off method on the dorsum of the 1^st toe just below the nail with 128-Hz tuning fork eight times.  Independent blinded evaluations were performed on each subject by two investigators who had completed a training session to standardize each exam.  Abnormal SWME testing was defined as at least one pedal site failing three monofilament assessments twice.  Abnormal vibratory sensation was defined as inability to determine pressure from vibration, or as having 5 of 8 tests abnormal on the on-off methodology.  Statistics were performed on SAS 9.3. We examined the inter-rater variability using Cohen’s Kappa.  We compared SWME and vibratory sensation in SSc to healthy controls using Fischer’s exact. T-test was used look at duration of disease and modified Rodnan skin score (mRSS) for those with abnormal SWME and vibratory sensation.  

Results: Mean age was 56.2 years for the SSc population and 49.4 years for the healthy control population (p: 0.7).   Disease distribution included 8 diffuse and 12 limited cutaneous SSc patients.   Two of 20 SSc patients reported sensory foot symptoms consistent with peripheral neuropathy, prior to the examination. Inter-rater agreement of SWME and vibration sensation was strong (kappa: 0.72 and 0.83, respectively).  Two healthy controls and 12 SSc patients demonstrated abnormal vibration sense (one-sided Fishers’ exact, p < 0.002). No healthy controls and 4 of the SSc had abnormal monofilament exam (one-sided Fishers exact, p= 0.053). The mRSS and duration of SSc did not differ between those with peripheral neuropathy as those without as diagnosed by these modalities (p: 0.07).

Conclusion: Patients with SSc have a high prevalence of pedal peripheral neuropathy, which may be asymptomatic and place them at risk for neuropathic complications.   Similar to persons with diabetes, SSc patients should be screened annually for peripheral neuropathy.  Those with significant abnormalities should be referred for routine podiatry care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/peripheral-neuropathy-a-complication-of-systemic-sclerosis/