Joint, bone, spine : revue du rhumatisme
-
Electrophysiological exploration of neuropathies is a standard method of investigating the dysfunction of myelinated larger fibers (Aalpha, Abeta). However, this method cannot test dysfunctions in other fibers. To evaluate the smaller (Adelta) and unmyelinated fiber (C-fibers) lesions a quantitative method has been perfected: the study of the sensory thresholds (quantitative sensory testing: QST). It allows the investigation of the sensory symptoms and is a reproducible, non-invasive and painless method. It is used above all in patients suffering from diabetic neuropathy ('Diabetes Care 9 (1987) 432'). ⋯ These results indicate that QST can detect the early dysfunction of the unmyelinated fibers in this kind of neuropathy. Subclinical detection can reduce severe neurological complications and make possible an early and effective treatment.
-
Hypophosphatemic osteomalacia is a rare but important complication of multiple myeloma. In these cases, the pathophysiology of the phosphate renal wasting notably differs from oncogenic osteomalacia and is due to light-chain nephropathy, resulting in proximal tubular dysfunction which is not restricted to phosphate handling. ⋯ For this reason hypophosphatemic osteomalacia is the presenting feature that leads to the diagnosis of multiple myeloma in most of these patients. Recognition of this complication is important, since supportive treatment with phosphate supplements and calcitriol may substantially alleviate pain and weakness associated with hypophosphatemia.