To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with leflunomide (LEF) by quantitative sensory testing (QST).
A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47 patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory findings, concomitant diseases, and medication history were evaluated at the time of QST. The cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured.
Age, gender, RA duration, ESR, and CRP did not show any significant differences between the two groups. VDT did not demonstrate any significant difference in both groups. However, CDT in LEF group was significantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these findings were not statistically significant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show significant correlation with CDT in both groups. VDT significantly correlated with age in both groups.
LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not affected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.
Citations
Objective: To obtain normal data of quantitative sensory test (QST) in Korean adult.
Method: The subjects were 85 normal adults aging from 30 to 69 years old, who had no abnormal sensory and neurologic problem. We performed following three QSTs on dominant side and one verbal questionnaire. 1) Semmes-Weinstein monofilament wire system (0.05 G, 0.2 G, 2 G, 4 G, 10 G, 300 G) for touch sensation, 2) Rydel-Seiffer Tuning Fork for vibration sensation, 3) TSA-2001 Thermal sensory analyser for thermal sensation, 4)University of Texas Subjective Peripheral Neuropathy verbal questionnaire.
Results: 1) Touch perception score measured with Semmes-Weinstein monofilament wire system, declined with age (p＜0.01). 2) Vibration perception score measured with the tuning fork, declined with age in foot (p＜0.01). 3) Warm sense and heat pain threshold measured with TSA-2001 thermal sensory analyser increased with age, and cold sense and cold pain threshold declined with age. 4) Weight showed negative correlation with vibration perception score in man's foot.
Conclusion: Normal data of three sensory test obtained from this study could be used for the early detection of peripheral neuropathy or loss of "protective sensation".
Objective: The purpose of this study was to determine whether quantitative sensory test can be used as a screening test of peripheral polyneuropathy in patients with diabetes mellitus, and to evaluate the severity of peripheral polyneuropathy in patients with diabetes mellitus using quantitative sensory test.
Method: We performed nerve conduction study to right upper and left lower extremity of the patients. Quantitative sensory test was performed using TSA-2001 thermal sensory analyser on right thenar and left foot dorsum in both diabetic and control groups.
Results: 1) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than age-matched control group (p＜0.05). 2) The warm sense and heat pain threshold were higher, the cold sense and cold pain threshold were lower in diabetic group than young-aged control group (p＜0.05). 3) As nerve conduction study results were severe, the cold sense threshold in right thenar were decreased (p＜0.05).
Conclusion: Quantitative sensory study in patients with diabetes mellitus are sensitive to identify neuropathic change; thus, they would be used as the screening method of diabetic peripheral polyneuropathy.
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