BOSTON – Autonomic symptom burden in patients with multiple sclerosis is associated with fatigue severity and quality of life, according to findings from a study of 100 patients.
Autonomic symptoms occur between attacks, can affect multiple organ systems, and have been well described in the literature as affecting up to 80% of patients, but are primarily attributed to chronic, long-term, long-phase duration of multiple sclerosis (MS) and progressive disease. The current findings show that autonomic symptoms are present during early disease stages and at low levels of disability, as well.
“We recognize the visceral symptoms the best, and we perhaps do the best job of identifying and treating these, but cardiovascular dysfunction is also described, and can be subclinical and less obvious to recognize in a symptomatic treatment setting,” Dr. Melissa M. Cortez said at the joint meeting of the European and Americas Committees for Treatment and Research in Multiple Sclerosis.
In fact, in this study the association between autonomic symptom burden and FSS scores were strongest when looking at orthostatic intolerance – one of five domains in the COMPASS-31 scale, a recently published, shortened version of the Autonomic Symptom Profile, said Dr. Cortez of the University of Utah, Salt Lake City.
“The findings raise the question of whether perhaps some of these symptoms are simply reflective of non‑disease-specific factors, or whether they actually are, in fact, reflecting aspects of disease burden that we’re not capturing well with established disease measures,” she said.
The 100 consecutive patients in the study had a mean age of 48 years and mean disease duration of 14.7 years. Their mean score on the COMPASS-31 scale was 27 out of a possible 100, and the mean Fatigue Severity Scale (FSS) score was 5 out of 7. Composite scores for the MS Quality of Life-54 (MSQOL-54) questionnaire were 58 out of 100 for physical health, and 65 out of 100 for mental health.
Significant correlations were found between COMPASS-31 and the MSQOL-54 composites (physical, r = ‑0.60; mental, r = ‑0.54), and the FSS (r = 0.51), Dr. Cortez reported.
COMPASS-31 score was not significantly associated with disease severity as measured by the Expanded Disability Status Scale, or with disease duration, said Dr. Cortez, who completed the study during her time as a fellow at the Mayo Clinic Arizona in Scottsdale, Ariz.
“The relationships persisted after adjustment for marital status, fatigue-causing medications, and depression,” Dr. Cortez noted.
Most (78%) of the patients in the study were women, and 84% had relapsing-remitting MS.
The finding of an association between autonomic symptom burden and increased fatigue severity, particularly in the orthostatic intolerance domain, highlights a clinical opportunity to assess and treat autonomic symptom burden. They also reveal a need to look more closely at whether autonomic function explains a portion of MS-related fatigue, she said.
“I think we need to do better at identifying what physiologic as well as functional measures can define both fatigue and autonomic dysfunction that would be relevant to this population. What I’d like to do next is think about whether or not treatments targeted at addressing this measurable autonomic dysfunction could then, in fact, alter MS-related fatigue, for example.”
Dr. Cortez reported having no disclosures.