Miral H Gharib, Georgios Ponirakis, Soha O M Dafaalla, Hoda Gad, Einas Elgassim, Hadeel B Zaghloul, Adnan Khan, Ioannis N Petropoulos, Gulfidan Bitirgen, Samar Al Emadi, Rayaz A Malik
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We assessed the utility of corneal confocal microscopy (CCM) for identifying small fibre damage in SLE in relation to disease activity, neuropathic pain and quality of life.</p><p><strong>Methods: </strong>Participants with SLE and healthy controls underwent CCM to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve fibre tortuosity (CNFT), inferior whorl length (IWL), Douleur Neuropathique 4 (DN4) Score, vibration perception threshold (VPT) and sudomotor function.</p><p><strong>Results: </strong>Participants with SLE (n=59; age 38.6±9.6 years; mean Systemic Lupus Erythematosus Disease Activity Index Score 3.4±4.2) had significantly lower CNBD (41.5±21.3 vs 72.1±29.4 branches/mm², p=0.0001) and CNFL (18.5±4.3 vs 24.2±4.4 mm/mm², p=0.0001) but comparable CNFD (31.7±7.1 and 34.0±6.9 fibres/mm<sup>2</sup>, respectively, p=0.25), CNFT (15.0±4.0 and 14.3±3.1, respectively, p=0.55), and IWL (38.5±8.0 and 35.6±5.9 mm/mm<sup>2</sup>, respectively, p=0.16) compared with healthy controls (n=17). Patients with SLE had a DN4 Score of 3.5±2.5 and elevated VPT (4.1±3.3 vs 2.8±0.7 V, p<0.01) but comparable sudomotor function of the hands and feet (p=0.28-0.42). Active SLE was associated with a lower CNBD/CNFD ratio (p<0.05). Patients with SLE associated with sustained neuropathic pain (17.2%) had significantly lower CNFD, CNFL and IWL than those with transient (p<0.05-0.0001) and recurrent (p<0.05-0.01) pain but comparable VPT (p=0.27) and sudomotor function (p=0.14). Reduced CNFL was associated with bodily pain, affecting quality of life (p<0.05).</p><p><strong>Conclusion: </strong>This study demonstrates that CCM detects peripheral neurodegeneration in patients with SLE, which relates to disease activity, sustained neuropathic pain and quality of life. CCM may serve as a rapid non-invasive neuroimaging technique to identify SFN in SLE.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Corneal confocal microscopy: a novel biomarker of small fibre neuropathy in SLE.\",\"authors\":\"Miral H Gharib, Georgios Ponirakis, Soha O M Dafaalla, Hoda Gad, Einas Elgassim, Hadeel B Zaghloul, Adnan Khan, Ioannis N Petropoulos, Gulfidan Bitirgen, Samar Al Emadi, Rayaz A Malik\",\"doi\":\"10.1136/lupus-2025-001645\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Small fibre neuropathy (SFN) is an under-recognised complication of SLE that contributes to chronic pain and reduced quality of life. We assessed the utility of corneal confocal microscopy (CCM) for identifying small fibre damage in SLE in relation to disease activity, neuropathic pain and quality of life.</p><p><strong>Methods: </strong>Participants with SLE and healthy controls underwent CCM to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve fibre tortuosity (CNFT), inferior whorl length (IWL), Douleur Neuropathique 4 (DN4) Score, vibration perception threshold (VPT) and sudomotor function.</p><p><strong>Results: </strong>Participants with SLE (n=59; age 38.6±9.6 years; mean Systemic Lupus Erythematosus Disease Activity Index Score 3.4±4.2) had significantly lower CNBD (41.5±21.3 vs 72.1±29.4 branches/mm², p=0.0001) and CNFL (18.5±4.3 vs 24.2±4.4 mm/mm², p=0.0001) but comparable CNFD (31.7±7.1 and 34.0±6.9 fibres/mm<sup>2</sup>, respectively, p=0.25), CNFT (15.0±4.0 and 14.3±3.1, respectively, p=0.55), and IWL (38.5±8.0 and 35.6±5.9 mm/mm<sup>2</sup>, respectively, p=0.16) compared with healthy controls (n=17). Patients with SLE had a DN4 Score of 3.5±2.5 and elevated VPT (4.1±3.3 vs 2.8±0.7 V, p<0.01) but comparable sudomotor function of the hands and feet (p=0.28-0.42). Active SLE was associated with a lower CNBD/CNFD ratio (p<0.05). Patients with SLE associated with sustained neuropathic pain (17.2%) had significantly lower CNFD, CNFL and IWL than those with transient (p<0.05-0.0001) and recurrent (p<0.05-0.01) pain but comparable VPT (p=0.27) and sudomotor function (p=0.14). Reduced CNFL was associated with bodily pain, affecting quality of life (p<0.05).</p><p><strong>Conclusion: </strong>This study demonstrates that CCM detects peripheral neurodegeneration in patients with SLE, which relates to disease activity, sustained neuropathic pain and quality of life. CCM may serve as a rapid non-invasive neuroimaging technique to identify SFN in SLE.</p>\",\"PeriodicalId\":18126,\"journal\":{\"name\":\"Lupus Science & Medicine\",\"volume\":\"12 2\",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-10-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lupus Science & Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/lupus-2025-001645\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus Science & Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/lupus-2025-001645","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：小纤维神经病变（SFN）是SLE的一种未被充分认识的并发症，可导致慢性疼痛和生活质量下降。我们评估了角膜共聚焦显微镜（CCM）在识别SLE中与疾病活动性、神经性疼痛和生活质量相关的小纤维损伤方面的效用。方法：SLE患者和健康对照者行CCM定量测定角膜神经纤维密度（CNFD）、角膜神经分支密度（CNBD）、角膜神经纤维长度（CNFL）、角膜神经纤维弯曲度（CNFT）、下螺纹长度（IWL）、Douleur神经病变4 （DN4）评分、振动感知阈值（VPT）和压迫运动功能。结果：SLE患者（n=59；年龄38.6±9.6岁；平均系统性红斑狼疮疾病活动指数评分3.4±4.2）的CNBD（41.5±21.3 vs 72.1±29.4支/mm²，p=0.0001）和CNFL（18.5±4.3 vs 24.2±4.4 mm/mm²，p=0.0001）显著降低，但CNFD（分别为31.7±7.1和34.0±6.9纤维/mm2， p=0.25）、CNFT（分别为15.0±4.0和14.3±3.1,p=0.55）和IWL（分别为38.5±8.0和35.6±5.9 mm/mm2, p=0.16）与健康对照组（n=17）相比具有可比较性。SLE患者DN4评分为3.5±2.5，VPT升高（4.1±3.3 vs 2.8±0.7 V）。结论：CCM检测SLE患者周围神经变性，与疾病活动性、持续神经性疼痛和生活质量有关。CCM可以作为一种快速的无创神经成像技术来识别SLE患者的SFN。
Corneal confocal microscopy: a novel biomarker of small fibre neuropathy in SLE.
Objective: Small fibre neuropathy (SFN) is an under-recognised complication of SLE that contributes to chronic pain and reduced quality of life. We assessed the utility of corneal confocal microscopy (CCM) for identifying small fibre damage in SLE in relation to disease activity, neuropathic pain and quality of life.
Methods: Participants with SLE and healthy controls underwent CCM to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve fibre tortuosity (CNFT), inferior whorl length (IWL), Douleur Neuropathique 4 (DN4) Score, vibration perception threshold (VPT) and sudomotor function.
Results: Participants with SLE (n=59; age 38.6±9.6 years; mean Systemic Lupus Erythematosus Disease Activity Index Score 3.4±4.2) had significantly lower CNBD (41.5±21.3 vs 72.1±29.4 branches/mm², p=0.0001) and CNFL (18.5±4.3 vs 24.2±4.4 mm/mm², p=0.0001) but comparable CNFD (31.7±7.1 and 34.0±6.9 fibres/mm2, respectively, p=0.25), CNFT (15.0±4.0 and 14.3±3.1, respectively, p=0.55), and IWL (38.5±8.0 and 35.6±5.9 mm/mm2, respectively, p=0.16) compared with healthy controls (n=17). Patients with SLE had a DN4 Score of 3.5±2.5 and elevated VPT (4.1±3.3 vs 2.8±0.7 V, p<0.01) but comparable sudomotor function of the hands and feet (p=0.28-0.42). Active SLE was associated with a lower CNBD/CNFD ratio (p<0.05). Patients with SLE associated with sustained neuropathic pain (17.2%) had significantly lower CNFD, CNFL and IWL than those with transient (p<0.05-0.0001) and recurrent (p<0.05-0.01) pain but comparable VPT (p=0.27) and sudomotor function (p=0.14). Reduced CNFL was associated with bodily pain, affecting quality of life (p<0.05).
Conclusion: This study demonstrates that CCM detects peripheral neurodegeneration in patients with SLE, which relates to disease activity, sustained neuropathic pain and quality of life. CCM may serve as a rapid non-invasive neuroimaging technique to identify SFN in SLE.
期刊介绍：
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.
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