Prevalence of peripheral neuropathy and its electrophysiological types in patients with systemic lupus erythematosus at Kenyatta National Hospital

Abstract

Background: Peripheral neuropathy, one of the neuropsychiatric syndromes of Systemic Lupus Erythematosus (SLE), occurs in 2% to 36% of patients. It has been associated with high disease activity indices and poor quality of life scores. Studies have demonstrated benefits of early identification and treatment on the severity and  progression of neuropathy. There is paucity of data on neurological manifestations of SLE in Africa.

Objective: To determine the prevalence of peripheral neuropathy using  clinical evaluation and Nerve Conduction Studies (NCS) and to describe its electrophysiological types using NCS; to determine and correlate quality of life with presence of peripheral neuropathy among SLE patients attending Kenyatta National Hospital (KNH), Rheumatology Clinic.

Design: This was a cross-sectional study of SLE patients attending  Rheumatology outpatient clinic at KNH.

Methods: Fourty eight patients with a diagnosis of SLE as per the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria who were 18 years and above were included in the study. Socio-demographic data and clinical information were obtained from the patients medical records. Structured history and clinical examination was performed on all patients. Lupus quality of life questionnaire was administered and nerve conduction studies performed on all patients.

Results: The overall prevalence of peripheral neuropathy was 60.4% (29 out of 48). Of these 27.1% were symptomatic for peripheral neuropathy and had abnormal nerve conduction studies while 25% were symptomatic for peripheral neuropathy and had normal nerve conduction studies. The other 8.3% had abnormal nerve conduction studies despite being asymptomatic. The most common nerve conduction pathology was  demyelination 9 (52.94%, n=17). However excluding 5 patients found to have Carpal tunnel syndrome, then demyelination was 4 (23.52%, n=17), while axonopathy was found in 5(29.41% n=17) of the patients. The most prevalent nerve conduction syndromes was motor neuropathy (52.94%, n=17). There was a significant correlation between the presence of peripheral neuropathy with lower quality of life scores involving the domains of physical health (p=<0.001), pain (p=0.012), planning  (p=0.003), and fatigue (p=0.005).

Conclusion: There is a high prevalence of peripheral neuropathy among SLE patients, with variable clinical and electrophysiologic  presentation. Quality of life scores are lower in affected patients.

Key words: Peripheral neuropathy, SLE, Kenya, Neuropsychiatric, Africa