Complex syndromes of chronic pain, fatigue and cognitive impairment linked to autoimmune dysautonomia and small fiber neuropathy, by Yehuda Shoenfeld, Varvara A Ryabkova, Carmen Scheibenbogen, Louise Brinth, Manuel Martinez-Lavine, Shuichi Ikeda, Harald Heidecke, Abdulla Watad, Nicola L Bragazzi, Joab Chapman, Leonid P Churilov, Howard Amital in Clinical Immunology vol 214, May 2020 [https://doi.org/10.1016/j.clim.2020.108384]
- Autoimmune aspects of CFS, POTS, CRPS and SIIS are discussed.
- The common denominators of anti-GPCR AAb and SFN are identified for these syndromes.
- A new concept of autoimmune neurosensory dysautonomia is suggested.
- Sjogren’s syndrome can illustrate the suggested concept.
Chronic fatigue syndrome, postural orthostatic tachycardia syndrome, complex regional pain syndrome and silicone implant incompatibility syndrome are a subject of debate among clinicians and researchers. Both the pathogenesis and treatment of these disorders require further study.
In this paper we summarize the evidence regarding the role of autoimmunity in these four syndromes with respect to immunogenetics, autoimmune co-morbidities, alteration in immune cell subsets, production of autoantibodies and presentation in animal models.
These syndromes could be incorporated in a new concept of autoimmune neurosensory dysautonomia with the common denominators of autoantibodies against G-protein coupled receptors and small fiber neuropathy. Sjogren’s syndrome, which is a classical autoimmune disease, could serve as a disease model, illustrating the concept.
Development of this concept aims to identify an apparently autoimmune subgroup of the disputable disorders, addressed in the review, which may most benefit from the immunotherapy.