Foot peripheral sensory neuropathy: a frequent disabling manifestation in systemic sclerosis

• Published in: Rheumatology (Oxford, England) Vol. 64; no. 6; pp. 3635 - 3642
• Main Authors: Alcacer-Pitarch, Begonya, Di Battista, Marco, Redmond, Anthony C, Keenan, Anne-Maree, Di Donato, Stefano, Buch, Maya H, Del Galdo, Francesco
• Format: Journal Article
• Language: English
• Published: England Oxford Publishing Limited (England) 01.06.2025; Oxford University Press
• Subjects: Adult; Age; Aged; Case-Control Studies; Clinical Science; Corticosteroids; Cross-Sectional Studies; Disability Evaluation; Feet; Female; Foot - innervation; Foot - physiopathology; Foot diseases; Foot Diseases - etiology; Foot Diseases - physiopathology; Humans; Male; Middle Aged; Neuropathy; Pain; Peripheral Nervous System Diseases - etiology; Peripheral Nervous System Diseases - physiopathology; Peripheral neuropathy; Quality of Life; Questionnaires; Scleroderma; Scleroderma, Systemic - complications; Scleroderma, Systemic - physiopathology; Systemic sclerosis; systemic sclerosis; quality of life; peripheral neuropathy; foot
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/keaf047

Peripheral sensory neuropathy (PSN) is an under-recognized feature in SSc. Moreover, SSc foot involvement is frequent but poorly investigated. We aimed to provide a detailed characterization of foot PSN in a large cohort of SSc patients, describing its associations with disease-specific features, physical disability and quality of life (QoL). SSc patients and healthy controls (HCs) comparable for age and gender were enrolled in a cross-sectional observational case-control study. All subjects underwent a detailed quantitative sensory testing of feet evaluating touch, vibratory, thermal and pain sensitivity, ultimately investigating the presence of large and small fiber neuropathy. Patient-reported outcomes (Scleroderma Health Assessment Questionnaire, Manchester Foot Pain and Disability Index and Systemic Sclerosis Quality of Life Questionnaire) were administered to assess neuropathic symptoms, foot disability and QoL. A total of 109 SSc patients (88.1% female, median age 59.0 years) and 51 HC were enrolled. SSc patients presented with a significant impairment in each sensory parameter assessed (P ≤ 0.01 for all). Foot PSN was present in 85.3% of the patients, with 80% having small fiber and 57% large fiber neuropathy, co-existing in 51.4% of the cases. PSN was associated with age, smoking, foot ulceration, disease duration and corticosteroids use. Precisely, 80.6% subjects with PSN reported at least one neuropathic symptom. Patients with neuropathic symptoms reported worse physical function, worse foot disability and more impaired QoL. Foot PSN presents as a common and disabling manifestation in SSc patients, involving small and large fibres. Hence, foot PSN assessment should be included as a part of the SSc workup.