What is your approach to the diagnostic workup of small fiber neuropathy in patients with known rheumatic disease?

In patients with established rheumatic disease, how do you approach the evaluation and diagnostic workup of suspected small fiber neuropathy?

• Primarily clinical assessment with limited additional testing
• Skin biopsy (intraepidermal nerve fiber density)
• Autonomic testing (ex. QSART, tilt table)
• Consider neurology referral
• Other