IS POTS AN AUTOIMMUNE DISEASE? The Connection Between Dysautonomia and Autoimmunity

It is a recognized fact that some autoimmune diseases  also cause POTS, like Sjogren's Syndrome or Systemic Lupus Erythematosus. This is because these diseases cause damage called neuropathy by causing your body to produce autoantibodies that attack nerve cells/fibers.


But is POTS itself an autoimmune disease?

I happen to have both. I found this interesting article on the subject. New evidence of autoimmunity in POTS!  

There are a few other autoimmune diseases known to cause POTS. Guillain-Barre Syndrome and  CIDP, Chronic Inflammatory Demyelinating Polyneuropathy. Guillain-Barre works both like an infection and an autoimmune disorder simultaneously. It causes nerve inflammation and damages the protective myelin sheath covering the nerves. As a result, the nerve signals travel too slowly and can result in the nerve fibers being totally destroyed. It usually comes on suddenly after a GI infection or lung infection. The end result is some degree of motor function loss or damage to the motor nerves. CIDP is a more chronic form of Guillain-Barre.

They did a study to find out whether or not Lupus patients who also had Fibromyalgia were more likely to have Orthostatic Tachycardia, also called Neurally mediated hypotension.

They found that 47.9% of Lupus patients had Neurally mediated hypotension(NMH), Seven of the patients in the study had NMS and POTS. Two patients had borderline results because they didn't show enough of a drop in systolic BP when they stood. 23% of the SLE patients had fibromyalgia.

Eighteen (23.7%) SLE patients had FM and 51 (67.1%) had at least one tender point (TP). The frequency of NMH (first or second stage) in SLE with FM was 58.3% compared with 69.4% in SLE without FM. This indicates that fibromyalgia and NMH being associated with Lupus isn't because NMH causes fibromyalgia.
http://rheumatology.oxfordjournals.org/content/43/5/609.full

This study found in Rheumatology International, July 2006, Volume 26, Issue 9, pp 837–840, showed that 37% of patients in the study who had Lupus also had autonomic symptoms. 18% of them had lab results showing autonomic dysfunction. This dysfunction didn't appear to have anything to do with how long they had had Lupus, lupus activity, disease damage, any particular organ involvement or the presence/absence of peripheral neuropathy. This means they could have autonomic dysfunction without having peripheral neuropathy. http://link.springer.com/article/10.1007%2Fs00296-005-0093-0

Sjogren's Disease effects most notably, the lacrimal glands,(your eyes) and salivary glands(your mouth)  by damaging your ability to produce tears and saliva. It can also damage your lungs, kidneys, bladder, joints, etc.  Sjogren's Disease  sometimes causes autonomic, sensory, and motor neuropathy, as well as CNS lesions/inflammation in the spinal cord and brain. Besides hypotension and tachycardia, these patients often have gastrointestinal problems, difficulty swallowing, headaches, body aches and nerve pain in the arms and legs. They may have hypersensitivity to light, sound, and skin sensation, outside of any migraines.

The thing I find most interesting about POTS and Sjogren's is that dehydration is a symptom of both illnesses. And anhydrosis or the inability to sweat or decreased sweating is a symptom of both diseases. In this case, Sjogren's destroys the sweat glands and in POTS it is caused by nerve damage.  And it would be difficult to tell which one causes which.


Another study  I read at The National Center for Biotechnology Information found the following:

"Patients with POTS have a higher prevalence of autoimmune markers and co-morbid autoimmune disorders than the general population. One in four patients have positive ANA, almost one in three have some type of autoimmune marker, one in five have a co-morbid autoimmune disorder, and one in nine have Hashimoto's thyroiditis." http://www.ncbi.nlm.nih.gov/pubmed/26038344

Other autoimmune conditions that occur with POTS are Multiple Sclerosis (MS),
Ehlers-Danlos Syndrome (EDS) which is more of a connective tissue disease than an autoimmune disease, Celiac Disease, Crohn's Disease, Addison's Disease, Graves Disease, Hashimoto's Thyroiditis, and antiphospholipid syndrome, and Rheumatoid Arthritis.

A severe form of dysautonomia is called Autoimmune Autonomic Ganglionopathy(AAG). Only around 100 people are diagnosed with it each year.