. Author manuscript; available in PMC: 2019 Jan 7.

Published in final edited form as: Curr Treatm Opt Rheumatol. 2017 Oct 24;3(4):275–288. doi: 10.1007/s40674-017-0076-9

Table 2.

Diagnosis of PNS manifestation of pSS

	Small fiber sensory neuropathy	Sensory ataxic neuropathy	Sensorimotor axonal neuropathy

Exam	Variable length dependence	Non-length-dependent	Length-dependent
	Abnormal pinprick/temperature	Pseudoathetosis	mild distal weakness
	Sensation DTR normal Vibratory sense normal	Abnormal proprioception Abnormal vibration Reduced DTR Abnormal Rombergs Test	Decreased or absent DTR
Neurodiagnostics	NCS/EMG:	NCS:	NCS:
	Normal	Low amplitude or unelicitable SEPs and SNAPs involving central/periphral rami of sensory neurons Motor nerve conduction normal (may be more frequently abnormal in paraneoplastic syndromes)	CMAP/SNAP amplitude reduction Conduction velocity: normal/slightly prolonged
Other	Skin biopsy	MRI:	Further evaluation
	Quantitative sensory test	T2 hyperintensity of posterior	Nerve biopsy
	for thermal sensations Laser evoked potentials Electrochemical skin conductance Sympathetic skin response	columns	Cryoglobulins
Differential	Diabetes mellitus or	HIV	Diabetes Mellitus
diagnosis^a,b,c	imparied glucose tolerance	Malignancy/paraneoplastic	Thyroid disease
	Hyperlipidemia	Bickerstaffs brainstem	Uremia
	Celiac disease	encephalitis	Tox’ns (alcohol, drugs)
	Infection (ie HIV) Toxins (drugs, alcohol) Other autoimmune (ie amyloidosis) Hereditary Monoclonal gammopathy or Paraneoplastic syndrome Idiopathic	Drugs (cisplatin, pyridox’ne)	Vitamin deficiency (B1, B12) Vasculitis Sarcoidosis Other autoimmune (SLE) Paraneoplastic syndrome Infection (HIV, Lyme disease, Leprosy) Porphyria

DTR deep tendon reflexes, NCS nerve conduction studies, EMG electromyography, SEP somatosensory evoked potential, SNAP sensory nerve action potential, CMAP compound muscle action potential

Birnbaum J. Peripheral nervous system manifestations of Sjogren syndrome: clinical patterns, diagnostic paradigms, etiopathogenesis, and therapeutic strategies. Neurologist. 2010;16(5):287-97

Mauermann ML et al. The evaluation of chronic axonal polyneuropathies. Semin Neurol. 2008;28(2):133-51

Lauria G. Small fiber neuropathies. Curr Opin Neurol. 2005;18(5):591-7