Dysautonomia in systemic lupus erythematosus: when to suspect and how to investigate.

Introduction: Among the neuropsychiatric manifestations of Systemic lupus erythematosus (SLE), there are manifestations related to the peripheral nervous system (PNS). The autonomic nervous system, a subdivision of the PNS, is poorly studied in patients with SLE, and most often not recognized in clinical practice. However, it's possible that autonomic impairment is more common than we thought and many manifestations without a clear pathophysiology may be explained by autonomic impairment.

Areas covered: This review is based on selected articles from the PUBMED database that evaluated autonomic dysfunction in SLE. Also explored some common symptoms in SLE without a clearly explanation, that can be due to autonomic impairment. Finally we proposed a clinical approach to autonomic evaluation in SLE.

Expert opinion: A wide range of clinical manifestations in SLE can be attributed to autonomic dysfunction, therefore it is important to search for this diagnosis to correctly treat patients and promote a better quality of life. The long-term impact of autonomic impairment is unknown and yet there is no biomarker that can help in the diagnosis.