A 65-year-old woman with biopsy-proven primary SS returned after a long hiatus with a five-month history of numbness, tingling, burning, and "creepy crawly" sensations, mostly in her extremities but sometimes affecting her trunk or scalp. The symptoms had progressed to the point where they were interfering with ambulation. She also reported memory loss and poor concnetration. Physical examination revealed dry mouth, absent ankle jerks (not unexpected in a woman of that age group), and right ankle dorsiflexor weakness. Sensory testing was equivocal and muscle enzymes were normal.
You suspect peripheral neuropathy. Which test are you least likely to order?
• Sural nerve and calf muscle biopsy
• Quantitative sensory testing
• Neurologic consultation for EMG/nerve conduction study of the lower extremities
• Cutaneous biopsy for epidermal nerve fiber density
• Serum Vitamin B12
Check your answer against other rheumatologists.* (Favored response is in bold face.)
* (Adapted from presentation and responses at a Curbside Consult session during the 2012 annual meeting of the American College of Rheumatology.)