Document Detail

Primary Sjogrens syndrome is associated with impaired autonomic response to orthostasis and sympathetic failure.
MedLine Citation:
PMID:  22976617     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Symptoms in keeping with autonomic dysfunction are commonly described by primary Sjögrens syndrome patients (pSS); whether objective abnormalities of autonomic function occur is unclear. This study set out to explore dynamic cardiovascular autonomic responses in pSS and their relationship with symptoms and quality of life.
METHODS: Twenty-one people from the UK pSS registry, 21 community controls and 21 patients with the autoimmune liver disease primary biliary cirrhosis (PBC) (matched case-wise for age and sex) attended for assessment of autonomic responses to orthostasis and Valsalva manoeuvre (VM). pSS patients also completed EULAR Sjögrens Syndrome patient-reported index (ESSPRI), EULAR Sjögren's syndrome disease activity index (ESSDAI), fatigue impact scale and EURO-QOL 5-dimension (EQ-5D).
RESULTS: Compared with controls, pSS patients had significantly lower baseline systolic blood pressure (SBP) (114 ± 13 vs. 127 ± 20; P = 0.02), which dropped to a significantly lower value (98 ± 22 vs. 119 ± 24, P = 0.009). When area under the curve (AUC) was calculated for when the SBP was below baseline this was significantly greater in pSS compared to both control groups (pSS vs. control vs. PBC: 153 ± 236 vs. 92 ± 85 vs. 1.2 ± 0.3, P = 0.005). Peak phase IV SBP during the VM was significantly lower in pSS (P = 0.007) indicating early sympathetic failure. Increased heart rate associated with fatigue (P = 0.02; r(2) = 0.2) and EQ-5D. A shift in sympathetic-vagal balance associated with overall symptom burden (ESSPRI) (P = 0.04, r(2) = 0.3) and EULAR sicca score (P = 0.016; r(2) = 0.3), the latter also correlated with baroreceptor effectiveness (P = 0.03; r(2) = 0.2) and diastolic blood pressure variability (P = 0.003; r(2) = 0.4).
CONCLUSION: pSS patients have impaired blood pressure response to standing. Dysautonomia correlates with PSS-associated symptoms and quality of life.
W-F Ng; A J Stangroom; A Davidson; K Wilton; S Mitchell; J L Newton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-13
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  105     ISSN:  1460-2393     ISO Abbreviation:  QJM     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-29     Completed Date:  2013-06-06     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  1191-9     Citation Subset:  IM    
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MeSH Terms
Area Under Curve
Autonomic Nervous System / abnormalities,  physiopathology*
Blood Pressure / physiology*
Case-Control Studies
Dizziness / epidemiology*,  etiology
Hypotension, Orthostatic / epidemiology,  etiology*
Middle Aged
Quality of Life
Sjogren's Syndrome / complications*,  physiopathology
Valsalva Maneuver
Grant Support
G0800629//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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