PO:34:214 | Autonomic Symptoms Are Associated with Neuropathic Pain Features and Disease Impact in Systemic Sclerosis: Results From a Cross-Sectional Study

Benedetta Bianchi¹, Francesca Francioso¹, Mariachiara Mangiafico¹, Fausto Salaffi¹, Rossella De Angelis¹, Marco Di Carlo¹ | ¹U.O. Reumatologia, Ospedale Carlo Urbani, Università Politecnica delle Marche Jesi, Italy

Objective. Dysautonomia is a recognized complication of systemic sclerosis (SSc). This study aimed to quantify the burden of autonomic dysfunction in SSc using the Composite Autonomic Symptom Score (COMPASS-31), a validated questionnaire assessing autonomic symptoms across six domains: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor functions (1). A secondary objective was to investigate the associations between autonomic symptoms and clinical, clinimetric, and imaging parameters.

Methods. Patients with SSc fulfilling the 2013 ACR/EULAR criteria were consecutively enrolled during routine outpatient visits. All participants completed the COMPASS-31 and additional questionnaires including the Gastroesophageal Reflux Disease Questionnaire (GERDQ) for reflux symptoms, the Modified Borg Scale (MBS) for dyspnea, the PainDetect Questionnaire (PDQ) for neuropathic pain features, and the Scleroderma Impact of Disease (ScleroID) score for overall disease burden. In a subset of patients who underwent high-resolution chest CT, the widest esophageal diameter was measured at three axial levels: above the aortic arch, between the right inferior pulmonary vein and the aortic arch, and between the diaphragmatic hiatus and the right inferior pulmonary vein. Associations between COMPASS-31 scores (total and domain-specific) and clinical or clinimetric data were assessed using Spearman’s rank correlation test. Multivariate regression analysis was performed to identify predictors of esophageal dilation.

Results. A total of 61 patients with SSc were enrolled (13 men and 48 women), of whom 44 had available chest CT data. The median COMPASS-31 total score was 17.5 (IQR 11.0–30.8). Higher COMPASS-31 scores correlated significantly with greater patient-reported disease impact as measured by the ScleroID (rho = 0.559, p < 0.001), reflux symptoms by GERDQ (rho = 0.356, p = 0.004), and neuropathic pain features by PDQ (rho = 0.553, p = 0.001). No significant associations were observed between COMPASS-31 scores and measures of esophageal dilatation on CT scans.

Conclusions. Autonomic symptoms in SSc are not isolated manifestations but are closely intertwined with patients’ perception of disease burden, including reflux, and the presence of neuropathic pain features. These findings highlight the multidimensional nature of dysautonomia in SSc and underscore the importance of incorporating routine assessment of autonomic symptoms into clinical practice. Recognizing and addressing dysautonomia may offer an opportunity to improve quality of life and functional outcomes in this complex patient population. Further studies are warranted to explore potential pathophysiological mechanisms and therapeutic targets.

Reference
1. Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin Proc. 2012 Dec;87(12):1196-201. doi: 10.1016/j.mayocp.2012.10.013. PMID: 23218087; PMCID: PMC3541923.