Assessment of the Most Distal Sensory Nerves in Patients with Rheumatoid Arthritis with Normal Value of Standard Nerve Conduction Studies

Kyung Min Ko¹, Sun Im² and Su-Jin Moon³, ¹Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South), ²Bucheon St. Mary's Hospital, College of Medicine, The Catholc University of Korea, Bucheon, Korea, Republic of (South), ³Bucheon St. Mary's Hospital, Division of rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Bucheon, Korea, Republic of (South)

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Neuropathy and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 7, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster III: Comorbidities

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Although it is generally accepted that peripheral neuropathy can occur in patients with rheumatoid arthritis (RA), most previous studies were conducted in RA patients with neurologic symptoms. We first evaluated the nerve conduction study (NCS) parameters of most distal sensory nerves of the lower extremities-namely the medial dorsal cutaneous (MDC), dorsal sural (DS), and medial plantar (MP) nerves as well as conventional nerves in RA patient, irrespective of neurologic symptoms.

Methods: Standard NCSs were performed on healthy controls (HC, n = 68), and RA group (n = 31). The bilateral NCS parameters of the MDC, DS, and MP nerves were investigated. The Toronto Clinical Scoring System (TCSS) was assessed.

Results: Age and BMI did not differ between the control and RA group. The mean TCSS scores of the RA and control groups were 5.8 ± 3.0 and 1.3 ± 0.9 respectively (p < 0.001). Although there were differences in NCS values of conventionally studied nerves (sural, superfical peroneal, median, and tibial nerves) between the two groups, the mean values of RA patients were within normal ranges. Interestingly, the RA group showed significant NCS differences in MDC, DS and MP nerves compared with the control group (p<0.001). The NCS parameters of most distal sensory nerves in RA group were not within normal values (mean ± 2 standard deviation). TCSS of RA patients showed significant associations with NCS values of most distal sensory nerves (onset amplitude of MP, sensory nerve action potential [SNAP] of MDC, peak amplitude of DS) (p < 0.05).

Conclusion: RA patients, despite of absence of evident neuropathic pain in most cases, showed axonal damage predominantly in most distal sensory large fiber. In patients with vague or equivocal neruopathic pain who showed normal findings on their routine NCS should be considered to evaluate whether they have early NCS changes in the most distal sensory large fiber such as MDC, DS and MP nerves.

Disclosure: K. M. Ko, None; S. Im, None; S. J. Moon, None.

To cite this abstract in AMA style:

Ko KM, Im S, Moon SJ. Assessment of the Most Distal Sensory Nerves in Patients with Rheumatoid Arthritis with Normal Value of Standard Nerve Conduction Studies [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/assessment-of-the-most-distal-sensory-nerves-in-patients-with-rheumatoid-arthritis-with-normal-value-of-standard-nerve-conduction-studies/. Accessed .

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