Systemic Sclerosis: What a Latvian Doctoral Study Found About Nerve Damage
A rheumatologist at Riga Stradiņš University has defended a doctoral thesis on systemic sclerosis. In a study of 103 patients in Latvia, 43% of those examined by electroneurography had nerve damage.
Systemic sclerosis, also called scleroderma, is a rare chronic autoimmune connective tissue disease. It can affect not only the skin but also blood vessels, lungs, heart, kidneys, and the digestive and nervous systems. LSM.lv has published an overview by a rheumatologist from Riga Stradiņš University (RSU) about her doctoral thesis and research by Latvian scientists.
Prevalence and symptoms
According to the thesis, in 2021 the disease occurred at a rate of 84 cases per million residents in Latvia. It was about four times more common in women than in men, and most prevalent among people aged 60 to 69.
One of the typical signs is Raynaud's phenomenon, in which fingers turn white or bluish in the cold or under stress. It was present in about 84% of patients in the study. As the disease progresses, skin may thicken and stiffen. Interstitial lung disease was found in about 36% of patients, pulmonary hypertension in about 27%, and esophageal motility disorders in about 40%.
Treatment
The disease cannot currently be cured completely, but treatment options have expanded considerably in recent years. Therapy is tailored to each patient's specific manifestations, and the approach is becoming more personalised. The latest guidelines of the European Alliance of Associations for Rheumatology (EULAR) contain 22 recommendations for eight main groups of manifestations.
The nervous system study
From 2016 to 2021, 159 patients were identified at Latvia's largest university hospitals, and 103 agreed to a more detailed examination. In electroneurography of 100 patients, damage to large nerve fibres, or polyneuropathy, was found in 43%. Of 57 patients without such damage, 38 agreed to an additional test, and 29 showed changes that may indicate damage to small nerve fibres.
Patients with polyneuropathy were older (on average 67 versus 57 years). It was more common in men, and each additional year of age raised the risk by about 9%. No convincing link with specific autoantibodies was found.
The biomarkers NfL, GFAP and GDF15 were significantly higher in patients with polyneuropathy. The author stresses that this is not yet a ready diagnostic test, but the direction merits further research.
