128 Abstract Introduction - Small fiber neuropathy (SFN) may present as complication in sarcoidosis. SFN can potentially result into a large range of symptoms with a high impact on quality of life. Although treatment of the underlying disease of SFN is paramount, little research has been performed to investigate SFN improvement as consequence of sarcoidosis treatment. This retrospective study investigates whether there is an association between the anti-inflammatory effects of infliximab and SFN-symptoms Methods - The Small Fiber Neuropathy Screening List (SFNSL) was used to measure changes in SFN symptoms during infliximab treatment. Maximal standardized uptake value (SUVmax) from Fluordeoxyglucose Positron Emission Tomography (FDG-PET) was used as a measure for inflammatory activity. Results – Thirty-six sarcoidosis patients were eligible for analysis. SFNSL-score showed a mean decrease of -1.9 points (p = 0.446). SUVmax did improve with a mean of -3.7 (p<0.001). No correlation between a decrease of SUVmax and SFNSL screening list could be found (p=0.610). Conclusion - Our data reveal no association between anti-inflammatory effect of infliximab and SFNrelated symptoms in patients with sarcoidosis, which contradicts previous case-reports and caseseries. Given the major negative impact of SFN-related symptoms on the quality of life in patients with sarcoidosis, it is necessary that the possible beneficial effect of anti-inflammatory therapy will be further addressed in future prospective studies. Introduction Sarcoidosis is a systemic granulomatous disease of unknown cause that most often affects the lungs and intrathoracic lymph nodes, but many other organs and tissues can also be involved.1,2 Clinical presentation and treatment of sarcoidosis depends on the organs affected. Pharmacological treatment of sarcoidosis is mostly initiated to either prevent specific organ damage or alleviate symptoms and includes corticosteroids, disease modifying anti rheumatic drugs (DMARDs) or antitumor necrosis factor alpha (anti-TNF-α) inhibitors like infliximab.3,4 Many symptoms in patients with sarcoidosis, however, are not organ specific and include fatigue, cognitive failure or pain which can be caused by small fiber neuropathy (SFN).5,6 Prevalence of SFN in patients suffering from sarcoidosis ranges between 60-86%5,7 and may contribute to a poor healthrelated quality of life (HRQL).5,8,9 The pathogenesis of SFN in sarcoidosis is unknown, but seems not related to direct granulomatous inflammation of small nerve fibers. However, some case reports demonstrate improvement of SFN related symptoms during anti-inflammatory treatment.10,11 Furthermore, the positive effects of ARA290, which can mitigate inflammation via innate immune receptors, also suggest a possible relationship between sarcoidosis inflammation and SFN related symptoms.12 This prompted us to further investigate a possible relation between inflammatory activity in sarcoidosis and SFN-related symptoms. Our hypothesis was that decrease in inflammation results in improvement of SFN-related symptoms in patients with sarcoidosis. Compared to biomarkers such as angiotensin converting enzyme (ACE) and soluble interleukin 2 receptor (sIL-2R), FDG-PET has the highest sensitivity for demonstrating inflammatory activity in patients with sarcoidosis13,14. In our local infliximab treatment protocol FDG-PET as well as the SFNSL are incorporated at baseline and during follow up. Therefore, 8 134 8
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