Abstract
Cornea confocal microscopy (CCM) is a novel non-invasive method to detect small nerve fiber pathology. CCM generally correlates with outcomes of skin biopsies in patients with small fiber pathology. The aim of this study was to quantify the morphology of small nerve fibers of the cornea of patients with fibromyalgia in terms of density, length and branching and further phenotype these patients using standardized quantitative sensory testing (QST). Small fiber pathology was detected in the cornea of 51% of patients: nerve fiber length was significantly decreased in 44% of patients compared to age- and sex-matched reference values; nerve fiber density and branching were significantly decreased in 10% and 28% of patients. The combination of the CCM parameters and sensory tests for central sensitization, (cold pain threshold, mechanical pain threshold, mechanical pain sensitivity, allodynia and/or windup), yielded four phenotypes of fibromyalgia patients in a subgroup analysis: one group with normal cornea morphology without and with signs of central sensitization, and a group with abnormal cornea morphology parameters without and with signs of central sensitization. In conclusion, half of the tested fibromyalgia population demonstrates signs of small fiber pathology as measured by CCM. The four distinct phenotypes suggest possible differences in disease mechanisms and may require different treatment approaches.
Highlights
Technique that has been developed to quantify small nerve fibers in the cornea[15,16]
The main aim of the current study was to quantify the heterogeneity of the fibromyalgia patient population and assess whether multiple subgroups with distinct phenotypes may be detected based on the morphological state of small fibers and standardized quantitative sensory testing and neuropathic pain questionnaires (PainDetect and small fiber neuropathy screening list, Small Fiber Neuropathy Screening List (SFNSL))
The main aim of this study was to assess the involvement of small fiber pathology in patients with fibromyalgia as quantified by confocal microscopy (CCM) and to relate cornea morphology results to patient-reported symptoms and standardized quantitative sensory testing (QST)
Summary
Technique that has been developed to quantify small nerve fibers in the cornea[15,16]. Nerve fiber counts in the cornea are generally correlated with skin biopsies, and correlate well with clinical symptoms of small fiber neuropathy especially in patients with patchy neuropathy[16,17,18]. The main aim of the current study was to quantify the heterogeneity of the fibromyalgia patient population and assess whether multiple subgroups with distinct phenotypes may be detected based on the morphological state of small fibers and standardized quantitative sensory testing and neuropathic pain questionnaires (PainDetect and small fiber neuropathy screening list, SFNSL). We hypothesized that small fiber pathology, as detected by CCM, is present in a subset of patients with fibromyalgia and that abnormalities in cornea small fiber morphology overlap with abnormalities in QST and questionnaires
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