title: Autonomic symptom burden in the hypermobility type of Ehlers-Danlos syndrome: a comparative study with two other EDS types, fibromyalgia, and healthy controls.
abstract: OBJECTIVE
  This study provides insight into the profile and importance of autonomic symptoms in the hypermobility type (HT) of Ehlers-Danlos syndrome (EDS). The impact of these symptoms is put into perspective by comparing with fibromyalgia (FM) and two other EDS types.
  
  
  METHODS
  Overall, 80 patients with EDS-HT participated, as well as 11 with classical EDS (cEDS), seven with vascular EDS (vEDS), 38 with FM, and 43 healthy controls. All participants filled out the autonomic symptom profile (ASP). Furthermore, they were inquired about quality of life (QOL, SF-36) and factors contributing to the EDS disease burden, e.g., hypermobility (5-point questionnaire, GHQ), fatigue (checklist individual strength, CIS), pain (pain detect questionnaire, PDQ), affective distress (hospital anxiety and depression scale, HADS), and physical activity (Baecke).
  
  
  RESULTS
  The total autonomic symptom burden was higher in EDS-HT (57.9 ± 21.57) than in controls (11.3 ± 19.22), cEDS (32.3 ± 19.47), and vEDS (29.1 ± 19.18), but comparable to FM (53.8 ± 19.85). Especially orthostatic and gastrointestinal complaints were prevalent. The importance of autonomic symptoms in EDS-HT was emphasized by the correlation with lowered QOL (r = -0.402), fatigue (r = 0.304), and pain severity (r = 0.370). Although affective distress and decreased physical activity are often suggested as possible causes for dysautonomia, the ASP did not correlate with the HADS and Baecke score. By contrast, the correlation of the GHQ (r = 0.298) and PDQ (r = 0.413) with the ASP supports the hypothesis that joint hypermobility and neuropathy may play a role in the development of autonomic symptoms.
  
  
  CONCLUSIONS
  Autonomic symptoms, especially orthostatic and gastrointestinal complaints, are frequent extraarticular manifestations of EDS-HT and contribute to the disease burden.
authors: Department of Rehabilitation Sciences and Physiotherapy, Ghent University-Artevelde University College, De Pintelaan 185, 1B3, Ghent 9000, Belgium. Electronic address: inge.dewandele@ugent.be.
authors: Inge
authors: I
authors: De Wandele
authors: Department of Rehabilitation Sciences and Physiotherapy, Ghent University-Artevelde University College, De Pintelaan 185, 1B3, Ghent 9000, Belgium.
authors: Patrick
authors: P
authors: Calders
authors: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors: Wim
authors: W
authors: Peersman
authors: Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
authors: Steven
authors: S
authors: Rimbaut
authors: Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
authors: Tine
authors: T
authors: De Backer
authors: Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
authors: Fransiska
authors: F
authors: Malfait
authors: Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
authors: Anne
authors: A
authors: De Paepe
authors: Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
authors: Lies
authors: L
authors: Rombaut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016022:Case-Control Studies; D015897:Comorbidity; D003863:Depression / Q000523:psychology; D004535:Ehlers-Danlos Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Autonomic symptoms; Dysautonomia; Ehlers–Danlos syndrome; Fatigue; Hypermobility; Pain; Quality of life