No fabry disease in patients presenting with isolated small fiber neuropathy

Bianca T.A. De Greef, Janneke G.J. Hoeijmakers, Emma E. Wolters, Hubertus J.M. Smeets, Arthur Van Den Wijngaard, Ingemar S.J. Merkies, Catharina G. Faber, Monique M. Gerrits

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Screening for Fabry disease in patients with small fiber neuropathy has been suggested, especially since Fabry disease is potentially treatable. However, the diagnostic yield of testing for Fabry disease in isolated small fiber neuropathy patients has never been systematically investigated. Our aim is to determine the presence of Fabry disease in patients with small fiber neuropathy. Methods: Patients referred to our institute, who met the criteria for isolated small fiber neuropathy were tested for Fabry disease by measurement of alpha-Galactosidase A activity in blood, lysosomal globotriaosylsphingosine in urine and analysis on possible GLA gene mutations. Results: 725 patients diagnosed with small fiber neuropathy were screened for Fabry disease. No skin abnormalities were seen except for redness of the hands or feet in 30.9% of the patients. Alfa-Galactosidase A activity was tested in all 725 patients and showed diminished activity in eight patients. Lysosomal globotriaosylsphingosine was examined in 509 patients and was normal in all tested individuals. Screening of GLA for mutations was performed for 440 patients, including those with diminished α-Galactosidase A activity. Thirteen patients showed a GLA gene variant. One likely pathogenic variant was found in a female patient. The diagnosis Fabry disease could not be confirmed over time in this patient. Eventually none of the patients were diagnosed with Fabry disease. Conclusions: In patients with isolated small fiber neuropathy, and no other signs compatible with Fabry disease, the diagnostic yield of testing for Fabry disease is extremely low. Testing for Fabrydisease should be considered only in cases with additional characteristics, such as childhood onset, cardiovascular disease, renal failure, or typical skin lesions.

Original languageEnglish
Article numbere0148316
JournalPLoS ONE
Volume11
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016
Externally publishedYes

Cite this

De Greef, B. T. A., Hoeijmakers, J. G. J., Wolters, E. E., Smeets, H. J. M., Van Den Wijngaard, A., Merkies, I. S. J., ... Gerrits, M. M. (2016). No fabry disease in patients presenting with isolated small fiber neuropathy. PLoS ONE, 11(2), [e0148316]. https://doi.org/10.1371/journal.pone.0148316
De Greef, Bianca T.A. ; Hoeijmakers, Janneke G.J. ; Wolters, Emma E. ; Smeets, Hubertus J.M. ; Van Den Wijngaard, Arthur ; Merkies, Ingemar S.J. ; Faber, Catharina G. ; Gerrits, Monique M. / No fabry disease in patients presenting with isolated small fiber neuropathy. In: PLoS ONE. 2016 ; Vol. 11, No. 2.
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title = "No fabry disease in patients presenting with isolated small fiber neuropathy",
abstract = "Objective: Screening for Fabry disease in patients with small fiber neuropathy has been suggested, especially since Fabry disease is potentially treatable. However, the diagnostic yield of testing for Fabry disease in isolated small fiber neuropathy patients has never been systematically investigated. Our aim is to determine the presence of Fabry disease in patients with small fiber neuropathy. Methods: Patients referred to our institute, who met the criteria for isolated small fiber neuropathy were tested for Fabry disease by measurement of alpha-Galactosidase A activity in blood, lysosomal globotriaosylsphingosine in urine and analysis on possible GLA gene mutations. Results: 725 patients diagnosed with small fiber neuropathy were screened for Fabry disease. No skin abnormalities were seen except for redness of the hands or feet in 30.9{\%} of the patients. Alfa-Galactosidase A activity was tested in all 725 patients and showed diminished activity in eight patients. Lysosomal globotriaosylsphingosine was examined in 509 patients and was normal in all tested individuals. Screening of GLA for mutations was performed for 440 patients, including those with diminished α-Galactosidase A activity. Thirteen patients showed a GLA gene variant. One likely pathogenic variant was found in a female patient. The diagnosis Fabry disease could not be confirmed over time in this patient. Eventually none of the patients were diagnosed with Fabry disease. Conclusions: In patients with isolated small fiber neuropathy, and no other signs compatible with Fabry disease, the diagnostic yield of testing for Fabry disease is extremely low. Testing for Fabrydisease should be considered only in cases with additional characteristics, such as childhood onset, cardiovascular disease, renal failure, or typical skin lesions.",
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De Greef, BTA, Hoeijmakers, JGJ, Wolters, EE, Smeets, HJM, Van Den Wijngaard, A, Merkies, ISJ, Faber, CG & Gerrits, MM 2016, 'No fabry disease in patients presenting with isolated small fiber neuropathy' PLoS ONE, vol. 11, no. 2, e0148316. https://doi.org/10.1371/journal.pone.0148316

No fabry disease in patients presenting with isolated small fiber neuropathy. / De Greef, Bianca T.A.; Hoeijmakers, Janneke G.J.; Wolters, Emma E.; Smeets, Hubertus J.M.; Van Den Wijngaard, Arthur; Merkies, Ingemar S.J.; Faber, Catharina G.; Gerrits, Monique M.

In: PLoS ONE, Vol. 11, No. 2, e0148316, 01.02.2016.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - De Greef, Bianca T.A.

AU - Hoeijmakers, Janneke G.J.

AU - Wolters, Emma E.

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AU - Van Den Wijngaard, Arthur

AU - Merkies, Ingemar S.J.

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N2 - Objective: Screening for Fabry disease in patients with small fiber neuropathy has been suggested, especially since Fabry disease is potentially treatable. However, the diagnostic yield of testing for Fabry disease in isolated small fiber neuropathy patients has never been systematically investigated. Our aim is to determine the presence of Fabry disease in patients with small fiber neuropathy. Methods: Patients referred to our institute, who met the criteria for isolated small fiber neuropathy were tested for Fabry disease by measurement of alpha-Galactosidase A activity in blood, lysosomal globotriaosylsphingosine in urine and analysis on possible GLA gene mutations. Results: 725 patients diagnosed with small fiber neuropathy were screened for Fabry disease. No skin abnormalities were seen except for redness of the hands or feet in 30.9% of the patients. Alfa-Galactosidase A activity was tested in all 725 patients and showed diminished activity in eight patients. Lysosomal globotriaosylsphingosine was examined in 509 patients and was normal in all tested individuals. Screening of GLA for mutations was performed for 440 patients, including those with diminished α-Galactosidase A activity. Thirteen patients showed a GLA gene variant. One likely pathogenic variant was found in a female patient. The diagnosis Fabry disease could not be confirmed over time in this patient. Eventually none of the patients were diagnosed with Fabry disease. Conclusions: In patients with isolated small fiber neuropathy, and no other signs compatible with Fabry disease, the diagnostic yield of testing for Fabry disease is extremely low. Testing for Fabrydisease should be considered only in cases with additional characteristics, such as childhood onset, cardiovascular disease, renal failure, or typical skin lesions.

AB - Objective: Screening for Fabry disease in patients with small fiber neuropathy has been suggested, especially since Fabry disease is potentially treatable. However, the diagnostic yield of testing for Fabry disease in isolated small fiber neuropathy patients has never been systematically investigated. Our aim is to determine the presence of Fabry disease in patients with small fiber neuropathy. Methods: Patients referred to our institute, who met the criteria for isolated small fiber neuropathy were tested for Fabry disease by measurement of alpha-Galactosidase A activity in blood, lysosomal globotriaosylsphingosine in urine and analysis on possible GLA gene mutations. Results: 725 patients diagnosed with small fiber neuropathy were screened for Fabry disease. No skin abnormalities were seen except for redness of the hands or feet in 30.9% of the patients. Alfa-Galactosidase A activity was tested in all 725 patients and showed diminished activity in eight patients. Lysosomal globotriaosylsphingosine was examined in 509 patients and was normal in all tested individuals. Screening of GLA for mutations was performed for 440 patients, including those with diminished α-Galactosidase A activity. Thirteen patients showed a GLA gene variant. One likely pathogenic variant was found in a female patient. The diagnosis Fabry disease could not be confirmed over time in this patient. Eventually none of the patients were diagnosed with Fabry disease. Conclusions: In patients with isolated small fiber neuropathy, and no other signs compatible with Fabry disease, the diagnostic yield of testing for Fabry disease is extremely low. Testing for Fabrydisease should be considered only in cases with additional characteristics, such as childhood onset, cardiovascular disease, renal failure, or typical skin lesions.

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De Greef BTA, Hoeijmakers JGJ, Wolters EE, Smeets HJM, Van Den Wijngaard A, Merkies ISJ et al. No fabry disease in patients presenting with isolated small fiber neuropathy. PLoS ONE. 2016 Feb 1;11(2). e0148316. https://doi.org/10.1371/journal.pone.0148316