Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Small fiber neuropathy is often a challenging clinical problem; patients with small fiber sensory neuropathy commonly have severe complaints but only minimal objective abnormalities on examination. Because it affects mainly small, unmyelinated nerve fibers, standard electrophysiological testing is often normal, and skin biopsy was proven to be diagnostic with sensitivity in 88% of cases in one study. The purpose of this study is to assess the effectiveness of IVIG in the treatment of SFN in patients with Fibromyalgia both subjectively (patient reported improvement in symptoms) and objectively by measuring nerve fiber density through skin biopsy before and after 6 months of treatment.
Methods: Our study is an interventional open labelled treatment trial, involving 7 patients diagnosed with Fibromylagia according to ACR criteria and had symptoms of SFN (ranging from chronic extremity pain, numbness or tingling)
All the 7 patients were diagnosed by Small fiber neuropathy after undergoing a 3 mm punch skin biopsy (1 on the thigh and one on the lower leg, as approved by the American Academy of Neurology) and the decrease in nerve fiber density was used for diagnosis of SFN)
All patients after being diagnosed with SFN on skin biopsy got 6 months of weight based IVIG treatment (2gm/kg).
Objective effectiveness of IVIG therapy was assessed by a repeat post treatment biopsy after completing the 6 months of treatment.
Subjective effectiveness was assessed by patient-filled FIQR questionnaires before and after treatment.
Patient demographics:
|
Age groups |
42-68 |
|
|
Male: Female ratio |
1:6 |
|
|
Prevalence of Fibromyalgia |
7 of 7 patients |
100% |
|
Prevalence of Rheumatoid |
3 of 7 patients |
42.86% |
|
Prevalence of Sjogren’s disease |
4 of 7 patients |
57.14% |
|
Prevalence of Sarcoidosis |
1 of 7 patients |
14.29% |
|
Prevalence of vitamin D deficiency |
3 of 7 patients |
42.86% |
Results:
Revised Fibromyalgia Impact Questionnaire ( FIQR) results before and after treatment:
|
Patient |
FIQR score before treatment |
FIQR score after treatment |
Magnitude of improvement change |
|
1 |
85 |
27 |
58 |
|
2 |
70 |
48 |
22 |
|
3 |
27 |
0 |
27 |
|
4 |
64 |
41 |
23 |
|
5 |
83 |
58 |
25 |
|
6 |
23.6 |
9.3 |
14.3 |
|
7 |
78 |
71 |
7 |
Nerve fiber diameter on skin Biopsy before and after treatment:
|
Pt |
Pretreatment upper thigh nerve fiber diameter |
Post-treatment upper thigh nerve fiber diameter |
Magnitude of change in upper thigh nerve diameter |
Pretreatment lower leg nerve fiber diameter |
Post-treatment lower leg nerve fiber diameter |
Magnitude of change in lower leg nerve diameter |
Net change of nerve fiber diameter |
|
1 |
3.9 mm |
9.3 mm |
+5.4 mm |
5.3 mm |
12.4 mm |
+7.1 mm |
+12.5 mm |
|
2 |
5.0 mm |
3.5 mm |
-1.5 mm |
0.4 mm |
1.6 mm |
+1.2 mm |
-0.3 mm |
|
3 |
3.6 mm |
11 mm |
+7.4 mm |
0.4 mm |
0.8 mm |
+0.4 mm |
+7.8 mm |
|
4 |
4.3 mm |
9.5 mm |
+5.2 mm |
0.3 mm |
0.0 mm |
-0.3 mm |
+4.9 mm |
|
5 |
2.6 mm |
4.9 mm |
+2.3 mm |
1.2 mm |
6.8 mm |
+5.6 mm |
+7.9 mm |
|
6 |
4.6 mm |
9.9 mm |
+5.3 mm |
5.5 mm |
4.3 mm |
-1.2 mm |
+4.1 mm |
|
7 |
3.0 mm |
3.6 mm |
+0.6 mm |
1.5 mm |
4.5 mm |
+3 mm |
+3.6 mm |
Mean improvement changes of FIQR score is 25, mean improvement of upper thigh nerve diameter is 3.5 mm, and mean improvement of lower leg nerve diameter is 5.7 mm.
Conclusion:
As shown in our study, IVIG has been proven to be very effective in improving SFN on both the clinical and the pathophysiologic levels and should be considered for the routine management of this underdiagnosed, yet very troublesome and crippling disease. Larger scale studies are definitely needed to confirm these results and facilitate the wider use of IVIG in treatment.
To cite this abstract in AMA style:
Metyas S, Youssef H, Chen C, Quismorio A, Bui J. Improvement in Fibromyalgia Symptoms and Skin Biopsy Results in Patients with Fibromyalgia and Small Fiber Neuropathy Treated with Intravenous Immune Globulin Infusion( IVIG) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/improvement-in-fibromyalgia-symptoms-and-skin-biopsy-results-in-patients-with-fibromyalgia-and-small-fiber-neuropathy-treated-with-intravenous-immune-globulin-infusion-ivig/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-in-fibromyalgia-symptoms-and-skin-biopsy-results-in-patients-with-fibromyalgia-and-small-fiber-neuropathy-treated-with-intravenous-immune-globulin-infusion-ivig/