title: Autonomic symptoms are common and are associated with overall symptom burden and disease activity in primary Sjogren's syndrome.
abstract: OBJECTIVE
  To determine the prevalence of autonomic dysfunction (dysautonomia) among patients with primary Sjögren's syndrome (PSS) and the relationships between dysautonomia and other clinical features of PSS.
  
  
  METHODS
  Multicentre, prospective, cross-sectional study of a UK cohort of 317 patients with clinically well-characterised PSS. Symptoms of autonomic dysfunction were assessed using a validated instrument, the Composite Autonomic Symptom Scale (COMPASS). The data were compared with an age- and sex-matched cohort of 317 community controls. The relationships between symptoms of dysautonomia and various clinical features of PSS were analysed using regression analysis.
  
  
  RESULTS
  COMPASS scores were significantly higher in patients with PSS than in age- and sex-matched community controls (median (IQR) 35.5 (20.9-46.0) vs 14.8 (4.4-30.2), p<0.0001). Nearly 55% of patients (vs 20% of community controls, p<0.0001) had a COMPASS score >32.5, a cut-off value indicative of autonomic dysfunction. Furthermore, the COMPASS total score correlated independently with EULAR Sjögren's Syndrome Patient Reported Index (a composite measure of the overall burden of symptoms experienced by patients with PSS) (β=0.38, p<0.001) and disease activity measured using the EULAR Sjögren's Syndrome Disease Activity Index (β=0.13, p<0.009).
  
  
  CONCLUSIONS
  Autonomic symptoms are common among patients with PSS and may contribute to the overall burden of symptoms and link with systemic disease activity.
authors.affiliation: Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
authors.forename: James
authors.initials: J
authors.lastname: Frith
authors.forename: Danielle
authors.initials: D
authors.lastname: Powell
authors.forename: Kate
authors.initials: K
authors.lastname: Hackett
authors.forename: Katharine
authors.initials: K
authors.lastname: Wilton
authors.forename: Simon
authors.initials: S
authors.lastname: Bowman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Price
authors.forename: Colin
authors.initials: C
authors.lastname: Pease
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Andrews
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: John
authors.initials: J
authors.lastname: Hunter
authors.forename: Monica
authors.initials: M
authors.lastname: Gupta
authors.forename: Saravanan
authors.initials: S
authors.lastname: Vadivelu
authors.forename: Ian
authors.initials: I
authors.lastname: Giles
authors.forename: David
authors.initials: D
authors.lastname: Isenberg
authors.forename: Peter
authors.initials: P
authors.lastname: Lanyon
authors.forename: Adrian
authors.initials: A
authors.lastname: Jones
authors.forename: Marian
authors.initials: M
authors.lastname: Regan
authors.forename: Annie
authors.initials: A
authors.lastname: Cooper
authors.forename: Robert
authors.initials: R
authors.lastname: Moots
authors.forename: Nurhan
authors.initials: N
authors.lastname: Sutcliffe
authors.forename: Michele
authors.initials: M
authors.lastname: Bombardieri
authors.forename: Costantino
authors.initials: C
authors.lastname: Pitzalis
authors.forename: John
authors.initials: J
authors.lastname: McLaren
authors.forename: Steven
authors.initials: S
authors.lastname: Young-Min
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Dasgupta
authors.forename: Bridget
authors.initials: B
authors.lastname: Griffiths
authors.forename: Dennis
authors.initials: D
authors.lastname: Lendrem
authors.forename: Sheryl
authors.initials: S
authors.lastname: Mitchell
authors.forename: Wan-Fai
authors.initials: WF
authors.lastname: Ng
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000453:epidemiology* / Q000503:physiopathology*; D006113:United Kingdom / Q000453:epidemiology