A 41-year-old man with polyarthritis and severe autonomic neuropathy

Figures & data

Figure 1 Pan-reduction of intrapidermal nerve fiber (IENF) density in the skin of the forearm, proximal leg, and distal leg with PGP 9.5 (Protein Gene Product) used as a fluorescent marker for IENF.

Table 1 Quantitative sensory tests: baseline, post-IVIG, and post-etanercept treatments. Note the improvement from baseline with IVIG and etanercept in vibration and monofilament pressure perception as well as warm and cold thermal thresholds

Quantitative sensory tests	Baseline Left great toe	Baseline Right great toe	Post-IVIG Left great toe	Post-IVIG Right great toe	Post-etanercept Left great toe	Post-etanercept Right great toe
Vibration (microns)	30.37	64.27	19.70	24.47	28.53	15.23
Pressure (Semmes-Weinstein Monofilaments)	3.41	4.21	2.64	3.12	2.83	2.93
Cold sensation (below 32 ºC)	7.0	10.4	2.9	3.6	3.1	10.9
Warm sensation (above 32 ºC)	13.6	12.4	11.4	6.9	11.7	8.9
Cold pain (below 32 ºC)	29.5	30.6	32.0	26.7	32.0	32.0
Heat pain (above 32 ºC)	>18.0	>18.0	16.9	14.9	18.0	18.0

Normal Ranges – Vibration (0–31 microns); Pressure (0–3.95 log g); Cold Sensation (0–10.5 ºC); Warm Sensation (0–12.4 ºC); Cold Pain (0–23.3 ºC); and Heat Pain (0–17.7 ºC).

Figure 2 Baseline and post-etanercept quantitative autonomic function tests demonstrating severe reduction in vagal sympathetic tone. Note the improvement in deep breathing and Valsalva responses after etanercept treatment.

Figure 3 Laser Doppler perfusion response to heating for baseline and post-etanercept treatment. The grey area is normal. a month and a half, we conclude his continued improvement in autonomic function is from the etanercept.