121 Assessment of autonomic dysfunction in patients with primary Sjogren's syndrome: relation to clinical aspect and immunological profiles

Abstract

Background: Primary Sjögren's syndrome (pSS) is an autoimmune disorder that affects exocrine glands and at least one-third of the patients develop multiorgan involvement. Peripheral neuropathy was reported in up to 25% of patients with a wide spectrum of neuropathic manifestations. Autonomic symptoms are common in patients with pSS and may lead to functional burden. This study was undertaken to assess the frequency of subjective dysautonomia in patients with pSS and to analyse its associations with disease activity and immunological profiles. Methods: Patients with pSS meeting the American European Consensus Group (AECG) classification criteria for Sjögren's syndrome were recruited. EULAR Sjögren's syndrome disease Activity Index (ESSDAI) used for disease activity assessment, visual analogue scale (VAS) score (0-10) for pain and fatigue VAS (fVAS) score (0-100) for fatigue. Antinuclear antibodies (ANA), anti-Ro/SSA and -La/SSB antibodies, and rheumatoid factor (RF) were done. Composite autonomic symptom score 31 (COMPASS 31) was used to assess symptoms of autonomic dysfunction. Results: A total of 31 pSS patients [96.8% female, mean (SD) age 47.3 (7.5) years, mean (SD) disease duration 5.3 (3.3) years] were included. Mean ESSDAI was 4≤1.5 (67.7% of patients had low disease activity while 32.3% had moderate activity). Mean pain score was 3.9≤2.07 and fatigue was 52.4≤22.8. The total COMPASS 31 score was 56≤11.06, with the most affected domains were orthostatic intolerance (30.06≤6.99) and secretomotor (11.4≤2.57). Patients with more active disease had significantly higher orthostatic intolerance and vasomotor scores as well as COMPASS 31 total score (Table 1). In addition, COMPASS 31 total score was significantly associated with Raynaud's phenomenon (P=0.001) and oral sicca (P=0.018), while correlated with ESSDAI (P<0.001), pain (<0.001) and fatigue (P=0.002). ESSDAI, pain and fatigue were all identified as predictors of COMPASS 31 total score (p=0.006), (p=0.012) and (p=0.029) respectively. Conclusion: Our findings indicate widespread symptoms of autonomic dysfunction in pSS patients that may exacerbate diseasespecific symptoms and associate with disease activity, pain and fatigue. (Table Presented).