Small fibre neuropathy and sarcoidosis, target for diagnosis and treatment?

To update the reader on recent evidence relating to symptoms, diagnostic strategies and management options for small-fibre neuropathy (SFN) in sarcoidosis. Learning points from recent studies are presented in the context of previous research forming the basis of our knowledge of SFN in patients with sarcoidosis.

Recent studies have shown overlap of SFN and other symptoms beyond pain in patients with sarcoidosis. Where SFN exists, determining the optimal diagnostic modalities is challenging; there have been developments in how forms of temperature threshold testing should be performed, as well as whether this test may miss patchy involvement by SFN in sarcoidosis. To aid identification of SFN in sarcoidosis, questionnaires has been developed specifically looking at sarcoidosis-associated SFN, attempting to capture the patients with patchy or intermittent SFN symptoms. Standard systemic management for sarcoidosis is ineffective for SFN, though infliximab shows promise and is increasingly being utilised as a treatment option.

Few studies have been published in the last two years but there have been developments that have progressed our knowledge. This review collates the latest research alongside prior work, aiming to help summarise diagnosis and management strategies for this problematic manifestation of sarcoidosis.