53 Abstract Introduction – Of all sarcoidosis patients 60-90% suffer from fatigue, 40-80% experience small fiber neuropathy, 35% suffer from cognitive impairment and 16-52% experience restless legs syndrome (RLS). The prevalence, severity and association between fatigue, pain, RLS and cognitive impairment in patients with sarcoidosis and small fiber neuropathy (SFN) is unknown and will be investigated in this study. Methods - Healthy controls, patients with sarcoidosis with SFN and patients with sarcoidosis without SFN were compared. They completed multiple questionnaires (fatigue assessment scale (FAS), RLS rating scale, visual analogue scale (VAS) score for pain and cognitive failure questionnaire (CFQ)), to estimate the prevalence, severity, and correlation of fatigue, RLS, pain, SFN and cognitive impairment. Results - Twenty healthy volunteers, 49 patients with sarcoidosis without SFN and 48 patients with sarcoidosis with SFN were included. Fatigue was the most prevalent symptom in patients with sarcoidosis with SFN (97%), followed by pain (85%), RLS (67%) and cognitive impairment (46%). Moreover, the severity of fatigue, pain, RLS and cognitive impairment was higher in patients with sarcoidosis with SFN compared with patients with sarcoidosis without SFN (resp. p=0.0006, p=0.003, p=0.02 and p=0.009). Finally, the FAS, RLS, VASmean, VASmax and CFQ showed a strong correlation with each other (R> 0.5, p<0.05). Conclusions - Sarcoidosis patients with SFN showed an increased prevalence and higher severity of fatigue, pain, RLS and cognitive impairment compared to patients with sarcoidosis without SFN. Moreover, moderate to strong correlations were found between these symptoms. Introduction Sarcoidosis is a granulomatous and systemic disorder of unknown cause, mainly affecting lungs and lymph nodes.1 Symptoms can be either organ specific, such as dyspnea in pulmonary sarcoidosis or rhythm disturbances in cardiac sarcoidosis, or in non-organ specific such as fatigue, restless legs syndrome (RLS), pain or cognitive impairment, often resulting in a decreased quality of life.2 Because these symptoms are independent of granulomas or disease activity, they are difficult to quantify, monitor and treat.2 Fatigue is the most frequently reported symptom in patients with sarcoidosis. The estimated prevalence varies between 60-90%, and over 25% of patients even report extreme fatigue.2 The cause of fatigue is so far unknown and might be multifactorial. Fatigue may even persist despite adequate sarcoidosis treatment and in absence of disease activity.3 Pain is also commonly reported in patients with sarcoidosis and seems to be associated with small fiber neuropathy (SFN).4 SFN is a disorder caused by damaged Aδ- and C-fibers nerve fibers5 with a prevalence of SFN-related symptoms in sarcoidosis patients between 40-86%.6,7 Cognitive impairment is reported in around 35% of sarcoidosis patients, and is characterized by loss of memory, concentration problems and decreased perception.8,9 In patients with neurosarcoidosis, the prevalence of cognitive impairment is higher and estimated to be 55%.8 Fatigue and symptoms suggestive of SFN were predictors of cognitive impairment in previous studies.10 Data on prevalence of cognitive impairment in patients with sarcoidosis-associated SFN is missing, but studies in patients 3 56 3
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