Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS)

Abstract

We believe that autonomic disorders in APS may represent an important clinical association with significant implications for treatment.

Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS)

“…Clinical evidence that POTS may have an autoimmune etiology has been mounting whereas POTS and other autonomic disorders have been observed in patients with multiple sclerosis, myasthenia gravis, Sjo¨gren's syndrome, SLE, RA and APS. [16][17][18][19] POTS can commonly occur after a viral illness 1 or after vaccination, 20 providing further evidence that an autoimmune and/or immunemediated process may underlie the etiology of POTS. However, the prevalence of autonomic disorders in patients with autoimmune conditions or the prevalence of autoimmune disorders in patients with POTS patients has not been determined.…”

“…This finding is in keeping with a previously reported case series of patients with aPL antibodies and POTS and other autonomic disorders. 19 Hashimoto's thyroiditis is an autoimmune inflammatory disease of the thyroid gland characterized by the lymphocytic infiltration of the thyroid gland. We found a higher prevalence of Hashimoto's thyroiditis in POTS patients compared to the general population (11% vs. up to 2%) (Table 2, Figure 1).…”

Recurrent Thromboembolic Events in a Patient With Dysautonomia: A Case Report

“…Cats that underwent vagus nerve stimulation developed a hyper-coagulable state [5]. Additionally, a recently published study proposes an association between POTS, neurocardiogenic syncope, and orthostatic hypotension and APS [6], leading the author to argue that POTS patients with migraines, memory loss, balance trouble, livedo reticularis, Raynaud's, history of miscarriage or family history of blood clots should all be tested for APS. Additionally, the underlying mechanism of autonomic instability that includes venous pooling could itself increase a person's risk for thrombosis as a component of Virchow's triad [7].…”

Evaluation of postural tachycardia syndrome (POTS)

“…The presence of flushing, typically present on the face and upper chest and hives, should alert the clinician to possible MCAS. Livedo reticularis may be seen in POTS patients with antiphospholipid antibody syndrome (Schofield et al, 2014).…”

“…POTS has been associated with antiphospholipid antibody syndrome (Schofield et al, 2014), as well as Sjögren syndrome (Goodman, 2017;Goodman et al, 2017). Further research is necessary to determine whether these conditions are causative of autonomic (and systemic) signs and symptoms in POTS, and most importantly whether there is a role for immunotherapy in these conditions.…”