half showed no SFN-associated symptoms and experienced a milder disease burden. This suggests that joint pain may be associated with sarcoidosis patients with a higher disease burden rather than SFN. Future research should provide more insight into joint symptoms in sarcoidosis patients and a possible association with disease burden. A limitation of our study was the subjective nature of the questionnaire. Consequently, it can be debated whether the described symptoms have a neuropathic origin. However, the questionnaire provides a unique overview of patient-reported SFN symptoms, which is a strength of this study. Additionally, the patients’ subjective sense of well-being significantly impacts quality of life5 and remains the major reason to initiate therapy. Another limitation of our study was the lack of 50 µm IENFD for the assessment of SFN, as proposed by the EFNS guidelines.26 This technique was not implemented due to the complex and timeconsuming protocol. The clinical complexity of IENFD assessment highlights the challenges of using this technique as a diagnostic standard for SFN. Moreover, low sensitivity of IENFD in sarcoidosis populations has been reported.27–29 The newly developed questionnaire offers added value in two ways. For research purposes, the SFNPQ identifies detailed symptom patterns, providing new insights into SFN-related symptoms and underlying mechanisms. For clinical practice, the first figure of the SFNPQ helps discriminate between length-dependent and continuous or intermittent origin of symptoms, as elaborated in another article.21 The SFNPQ may also enhance clinical awareness of muscular and joint symptoms. Conclusion Cutaneous symptoms in the feet and muscular symptoms in the legs showed the highest prevalence in sarcoidosis-associated SFN (67% and 77% respectively). Joints symptoms were highly prevalent in patients with sarcoidosis, both with and without SFN. Finally, the SFNPQ was able to discriminate characteristics and anatomical origins of SFN-related symptoms, which adds value for future research as well as for clinical purposes. 4 76 4
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