--or multiply morbid, in that you do have numerous reinforcing conditions.

First, much of the neuropathy in diabetes and the vascular autoimmune conditions such as Sjogrens and lupus is actually vascular in nature; the elastic connective tissue in blood vessel is attacked and this means less nutrition and oxygen gets to the nerves and less waste products are carried away, compromising them over time. It's not that there can't be direct autoantibody action on the components of the nerves themselves--that happens, too--but the primary mechanism seems to be vascular in nature.

Moreover, this lead one far more prone to compressive nerve effects. I have talked in the past about the "double crush phenomenon"--nerves already damaged by systemic conditions tend to produce enhanced symptoms when mechanically damaged, such as by spinal foraminal or disc issues. I'm quite living proof of that, having issues with both my cervical and sacral spines where the symptoms are enhanced by the nerve damage I experienced in my bout of body wide acute onset small fiber neuropathy back in 2003--I have recovered considerably from that, but residual effects, and the fact that regenerating nerves may grow back in different pathways, fighting their way around or through other body structures, have resulted in more symptoms from my spine issues than one would suspect just from looking at my MRI's is quite probable.

This is why people with multiple issues need to be seen at tertiary medical facilities that not only do research but have multiple coordinated specialists--and ones who communicate readily. Don't know how much access you might have to such a facility, but it's probably better than dealing with doctors in smaller practices.