Small Fibre Polyneuropathy As a Therapeutic Target for Patients with Interstitial Cystitis/Bladder Pain Syndrome, 2023, Whitman

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https://www.auajournals.org/doi/abs/10.1097/JU.0000000000003229.02

PD05-02 SMALL FIBER POLYNEUROPATHY AS A THERAPEUTIC TARGET FOR PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME
Wyatt Whitman, Maxwell Sandberg, Dylan Wolff, Raymond Xu, Tyler Overholt, Robert Evans,
Catherine Matthews, Gopal Badlani, and Stephen Walker

https://doi.org/10.1097/JU.0000000000003229.02

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Abstract

INTRODUCTION AND OBJECTIVE:
In addition to a variety of co-occurring urological and non-urological symptoms and syndromes, we have found that ∼30% of patients with a diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) also have small fiber polyneuropathy (SFPN). The objective of this study was to determine the association between SFPN and co-occurring symptoms and syndromes in IC/BPS patients.


METHODS:
Skin biopsies were taken from the distal calf of IC/BPS patients who were undergoing therapeutic hydrodistension (HOD). SFPN status (+ or -) was determined by counting intraepidermal nerve fibers (IENF) in a stained section from the biopsy and comparing the IENF density to normative reference values. Patient characteristics such as anesthetic bladder capacity (BC), Hunner lesion (HL) status, and glomerulations were determined at the time of hydrodistension under direct cystoscopy. Patient demographics, co-occurring medical conditions, and symptomatology was obtained via patient reports and review of medical records. To test for an association of SFPN+ with demographic and clinical characteristics, an optimized logistic regression model was created using variables with p<0.1 on univariable analysis and/or those with an established clinical relevance. Standard logistic regression diagnostics were utilized to ensure the model fit to the data


RESULTS:
Between October 2019 and April 2022 153 participants were enrolled (134F;19M). Mean age was 50.32 (±15.32). Overall, one third (50/153) were SFPN+. There was a statistically significant difference in the adjusted odds ratios (OR, [95% CI]) between the SFPN+ and SFPN- groups for chronic fatigue syndrome (3.054, [1.22, 7.68]) and diabetes mellitus (4.185, [1.471, 11.90]).


CONCLUSIONS:
SFPN is common in patients with IC/BPS and is significantly associated with concomitant diagnoses of chronic fatigue syndrome and diabetes mellitus. These findings suggest that for a large subset of IC/BPS patients that have a systemic pain disorder, SFPN may provide an important new therapeutic target.

Source of Funding:
R01 DK124599