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

Small fiber sensory neuropathy (SFN), in general, including in patients with rheumatic diseases, should be suspected based on symptoms (positive more than negative sensory symptoms) and ideally confirmed by clinical examination showing altered temperature and/or pain/pinprick perception in the limbs...

In most cases, I would give them a clinical diagnosis without supportive testing. Usually, it doesn’t change management since I don’t offer IVIG for small fiber neuropathy, nor do I escalate immunosuppression.

In addition, let’s say the result is positive - it could still be from diabetes, nutrition...

In a setting of comorbidity known to be associated with small-fiber neuropathy, the clinical symptoms and neurological examination findings are consistent with small-fiber sensory neuropathy; a limited diagnostic study, including a nerve conduction study, is all that is needed to support the diagnos...