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Open Access Highly Accessed Research article

Mild autonomic dysfunction in primary Sjögren's syndrome: a controlled study

Fin ZJ Cai1, Sue Lester12, Tim Lu1, Helen Keen1, Karyn Boundy3, Susanna M Proudman4, Anne Tonkin5 and Maureen Rischmueller15*

Author Affiliations

1 Rheumatology Department, The Queen Elizabeth Hospital, Woodville Road, Woodville South, 5011, Australia

2 Hanson Institute, Frome Road, Adelaide, 5000, Australia

3 Neurology Department, The Queen Elizabeth Hospital, Woodville Road, Woodville South, 5011, Australia

4 Rheumatology Department, The Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia

5 School of Medicine, University of Adelaide, Frome Road, Adelaide, 5000, Australia

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Arthritis Research & Therapy 2008, 10:R31  doi:10.1186/ar2385

Published: 7 March 2008

Abstract

Introduction

The aim of this study was to compare cardiovascular autonomic nervous system function in patients with primary Sjögren's syndrome (pSS) with that in control individuals, and to correlate the findings with autonomic symptoms and the presence of exocrine secretory dysfunction.

Methods

Twenty-seven female patients with pSS and 25 control individuals completed the COMPASS (Composite Autonomic Symptom Scale) self-reported autonomic symptom questionnaire. Beat-to-beat heart rate and blood pressure data in response to five standard cardiovascular reflex tests were digitally recorded using a noninvasive finger pressure cuff and heart rate variability was analyzed by Fourier spectral analysis. Analysis was performed by analysis of variance (ANOVA), multivariate ANOVA and repeated measures ANOVA, as indicated. Factor analysis was utilized to detect relationships between positive autonomic symptoms in pSS patients.

Results

Multiple, mild autonomic disturbances were observed in pSS patients relating to decreased heart rate variability, decreased blood pressure variability and increased heart rate, which were most evident in response to postural change. There was a strong trend toward an association between decreased heart rate variability and increased severity of the secretomotor, orthostatic, bladder, gastroparesis and constipation self-reported autonomic symptom cluster identified in pSS patients. This symptom cluster was also associated with fatigue and reduced unstimulated salivary flow, and therefore may be an important component of the clinical spectrum of this disease.

Conclusion

There was evidence of mild autonomic dysfunction in pSS as measured with both cardiovascular reflex testing and self-reported symptoms. Pathogenic autoantibodies targeting M3 muscarinic receptors remain a strong candidate for the underlying pathophysiology, but practical assays for the detection of this autoantibody remain elusive.