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Small Fibre Neuropathy Sjogren — SCE Rheumatology MCQ

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HardConnective Tissue DiseaseSmall Fibre Neuropathy SjogrenSCE Rheumatology

A patient with primary Sjögren disease has burning foot pain and impaired pinprick sensation, but routine nerve-conduction studies are normal. What neuropathy is most likely?

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Correct answer: E — Small-fibre neuropathy not assessed by routine nerve-conduction studies

The best answer is “Small-fibre neuropathy not assessed by routine nerve-conduction studies”. Routine studies assess large myelinated fibres, so small-fibre neuropathy can produce burning pain and pinprick change despite normal results. Large-fibre and median neuropathies usually alter conduction, motor-neuron disease does not cause this sensory syndrome, and normal studies do not exclude small-fibre disease.

Reference: BSR Sjögren disease guideline: https://academic.oup.com/rheumatology/article/64/2/409/7645909