Presented at the 2012 AAPM Annual Meeting « Back

Regeneration of Intraepidermal Nerve Fibers with Infrared LED Care in a 54-Year-Old Female with Sjogren’s Syndrome: A Case Report

Joseph O. DiDuro, DC DABCN, drjoe.az@gmail.com, Neuropathy Treatment Centers of America, Phoenix, Arizona

Sjögren's syndrome is a disorder in which the immune system attacks the body's moisture-producing glands, such as the tear glands and the saliva glands. These glands may become scarred and damaged, and extreme dryness in the eyes and mouth (sicca syndrome) may develop. Sjögren's syndrome may also cause fatigue, pain in the joints, and problems with the function of vital organs, such as the lungs, kidneys, and nerves. We describe a case of documented Sjögren's syndrome and peripheral neuropathy pain showing Intraepidermal Nerve Fibers regeneration and symptomatic improvement after Infrared LED care. A 54-year-old female tripped and fell on her knee and subsequently developed progressive pain throughout the whole leg. She had multiple therapies with no improvement including physical therapy, acupuncture, chiropractic, epidurals and sympathetic blocks. Blood work revealed elevated serum creatine, high anti-SS-A and vitamin B12, low fasting glucose 2 hr, and Positive ANA Direct. IENFD was significantly decreases in the lower thigh and calves bilaterally. The patient was placed on 3 months of IV Ig and IR LED therapy. At follow-up, she reported her pain was significantly improved, she was no longer taking her pain medication and she was no longer limping. IEDNF densities returned to normal in the IR LED treated calves while further degeneration was observed in the non-treated thigh areas. This is one of the first illustrations of epidermal reinnervation coinciding with clinical and symptomatic improvement of a painful sensory neuropathy in a patient with Sjogren’s syndrome. References: 1)Gøransson LG, Herigstad A, Tjensvoll AB, Harboe E, Mellgren SI, Omdal R: Peripheral neuropathy in primary sjogren syndrome: a population-based study. Arch Neurol 2006, 63:1612-5. 2)Chai J, Herrmann DN, Stanton M, Barbano RL, Logigian EL: Painful small-fiber neuropathy in Sjögren syndrome. Neurology 2005,65:925-927. 3)Lauria G, Devigili G: Skin biopsy as a diagnostic tool in peripheral neuropathy. Nat Clin Pract Neurol 2007, 3:546-57. 4)Penza P, Lombardi R, Camozzi F, Ciano C, Lauria G: Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy. Neurol Sci 2009, 30:149-51. 5)Pittenger GL, Ray M, Burcus NI, McNulty P, Basta B, Vinik AI: Intraepidermal nerve fibers are indicators of small-fiber neuropathy in both diabetic and nondiabetic patients. Diabetes Care 2004, 27:1974-9. 6)Shun CT, Chang YC, Wu HP, Hsieh SC, Lin WM, Lin YH, Tai TY, Hsieh ST: Skin denervation in type 2 diabetes: correlations with diabetic duration and functional impairments. Brain 2004, 127:1593-605. 8. Smith AG, Russell J, Feldman EL, Goldstein J, Peltier 7)Nodera H, Barbano RL, Henderson D, Herrmann DN: Epidermal reinnervation concomitant with symptomatic improvement in a sensory neuropathy. Muscle Nerve 2003, 27:507–509 8)Chao CC, Sun HY, Chang YC, Hsieh ST: Painful neuropathy with skin denervation after prolonged use of linezolid. J Neurol Neurosurg Psychiatry 2008, 79:97-9. 9)McArthur JC, Stocks EA, Hauer P, Cornblath DR, Griffin JW: Epidermal nerve fiber density: normative reference range and diagnostic efficiency. Arch Neurol 1998, 55:1513–1520. 10)Polydefkis M, Yiannoutsos CT, Cohen BA, Hollander H, Schifitto G, Clifford DB, Simpson DM, Katzenstein D, Shriver S, Hauer P, Brown A, Haidich AB, Moo L, and McArthur JC: Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neu

Funding: None