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Association between anti-inflammatory effect of infliximab and small fiber neuropathy symptoms in patients with sarcoidosis

Effects of anti-TNF-alpha on SFN and sarcoidosis


  • Lisette Raasing
  • Oscar J.M. Vogels ILD Center of Excellence, Department of Neurology, St Antonius Hospital (3435 CM, Nieuwegein, The Netherlands)
  • Marcel Veltkamp ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital (3435 CM, Nieuwegein, The Netherlands)
  • Jan C. Grutters Division of Heart and Lungs, University Medical Center Utrecht (3584 CX, Utrecht, The Netherlands)



small fiber neuropathy, sarcoidosis, infliximab, treatment, SFNSL


Introduction Small fiber neuropathy (SFN) may present as complication in sarcoidosis.1 SFN can potentially result into a large range of symptoms with a high impact on quality of life.2 Although treatment of the underlying disease of SFN is paramount, little research has been performed to investigate SFN improvement as consequence of sarcoidosis treatment. This retrospective study investigates whether there is an association between the anti-inflammatory effects of infliximab and SFN-symptoms 

Methods The Small Fiber Neuropathy Screening List (SFNSL) was used to identify changes in SFN symptoms during Infliximab treatment. Maximal standardized uptake value (SUVmax) from Fluordeoxyglucose Positron Emission Tomography (FDG-PET) was used as a measure for inflammatory activity. To investigate the effects of Infliximab on inflammatory activity, a subdivision was made defined as improved, stable and worsened SFNSL-score.

            Results 45 sarcoidosis patients were eligible for analysis. SFNSL-score showed a mean decrease of -3 points (p = 0.207). SUVmax did improve with a mean of 3.44 (p=<0.001). In the subgroups of ameliorated, stable and worse SFN-related symptoms, only in the latter subgroup the improvement of FDG uptake was not clinically relevant.

            Discussion In patients with active inflammatory sarcoidosis defined by FDG-PET, Infliximab treatment showed an improvement of the SFNSL-score in 51% of patients. In these patients a significant decrease of sarcoidosis inflammation measured by FDG-PET was also found. In most of the patients without clinically relevant improvement of SUVmax, the SFNSL-score worsened. These data could open a discussion about whether persistent inflammation in sarcoidosis can be detrimental to symptoms of SFN.


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Original Articles: Clinical Research

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