A consult was sent to Rheumatology: a patient with small fiber neuropathy and lower extremity ulcerations. Patient does not have diabetes or vitamin B12 deficiency and is treated by Neurology with Cymbalta and Neurontin. What do you think? Arthritis Rheum. 2013 Dec 10. doi: 10.1002/art.38302. [Epub ahead of print] Peripheral neuropathies in systemic lupus erythematosus (SLE): Clinical features, disease associations, and immunological characteristics evaluated over a 25-year study period. Oomatia A, Fang H, Petri M, Birnbaum J. Abstract Objective: We sought to characterize peripheral neuropathy subtypes, ancillary studies, and immunological profiles associated with peripheral neuropathies in patients with systemic lupus erythematosus (SLE). Methods: In this 25-year study of 2,097 SLE patients, we characterized peripheral neuropathies due to SLE, and compared the association of clinical and SLE-related features in patients with versus without neuropathy. Results: The prevalence of peripheral neuropathies was 5.9% (123/2,097), with 66.7% (82/123) having peripheral neuropathies attributable to SLE. We noted that 17.1% (14/82) of patients with peripheral neuropathies due to SLE had small-fiber neuropathies, which is a painful neuropathy not included in the American College of Rheumatology neuropsychiatric SLE (ACR NPSLE) case definitions. SLE patients with small-fiber neuropathies could present with unorthodox neuropathic pain patterns not consistent with a stocking-and-glove distribution, and had associated skin biopsies suggestive of dorsal root ganglia neuronal cell loss. Compared to SLE patients without peripheral neuropathies, peripheral neuropathy patients had lower mean disease activity (p=0.01), higher disease damage (p
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