{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:03:02Z","timestamp":1790697782499,"version":"4.1.0"},"reference-count":34,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2026,9,19]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic accuracy of the Arabic Composite Autonomic Symptom Score-31 (COMPASS-31) for detecting objectively confirmed autonomic neuropathy in patients with SLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional diagnostic accuracy study, 45 patients with SLE, 23 patients with neurologically confirmed autonomic neuropathy (positive-control group), and 45 healthy controls completed the Arabic COMPASS-31 before undergoing cardiovascular autonomic reflex testing (CART) and sympathetic skin response (SSR). Objective autonomic neuropathy was defined as abnormal CART and\/or absent SSR. Diagnostic accuracy analyses (receiver operating characteristic (ROC) curve analysis, optimal cut-off determination and multivariable logistic regression) were performed within the SLE cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Objective autonomic neuropathy was present in 28 of 45 patients with SLE (62%). Total COMPASS-31 score discriminated autonomic neuropathy status with an area under the ROC curve (AUC) of 0.81 (95% CI 0.68 to 0.94) at a cut-off of \u22655 (sensitivity 89% and specificity 59%), increasing to 0.89 (95% CI 0.79 to 0.98) when restricted to definite\/severe autonomic neuropathy. The orthostatic intolerance (AUC 0.78, 95% CI 0.64 to 0.91) and pupillomotor (AUC 0.77, 95% CI 0.64 to 0.90) domains performed similarly to the total score (DeLong\u2019s test, both p&gt;0.4), while the vasomotor, secretomotor, gastrointestinal and bladder domains performed significantly worse. The COMPASS-31 total score remained independently associated with autonomic neuropathy after adjustment for age, disease duration and disease activity (adjusted OR 1.29, 95% CI 1.06 to 1.57). Internal consistency of the Arabic COMPASS-31 was good (Cronbach\u2019s \u03b1=0.83, McDonald\u2019s \u03c9=0.857).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Arabic COMPASS-31 demonstrates good discrimination for objectively confirmed autonomic neuropathy in SLE, with the orthostatic intolerance and pupillomotor domains contributing most of its discriminative value. It can be used as a screening tool to identify patients who warrant confirmatory autonomic testing. Disease-specific validation should precede recommending COMPASS-31 as an autonomic neuropathy screening tool in other rheumatic diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2026-002287","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:44:48Z","timestamp":1790693088000},"page":"e002287","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of the Arabic composite autonomic symptom score 31 (COMPASS-31) for detecting autonomic neuropathy in SLE: a cross-sectional validation study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3392-6603","authenticated-orcid":false,"given":"Omima Ahmed","family":"El-Farra","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Minia University, Menia Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen Abdelhakim","family":"Abdelnaby","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Minia University, Menia Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6801-6012","authenticated-orcid":false,"given":"Hassan M H","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Minia University, Menia Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha N","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Minia University, Menia Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9896-9028","authenticated-orcid":false,"given":"Shereen R","family":"Kamel","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Minia University, Menia Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092908103073000_13.2.e002287.1","doi-asserted-by":"crossref","DOI":"10.1136\/lupus-2021-000507","article-title":"Characteristics of cardiovascular autonomic dysfunction and association with quality of life in patients with systemic lupus erythematosus","volume":"8","author":"Zinglersen","year":"2021","journal-title":"Lupus Sci Med"},{"key":"2026092908103073000_13.2.e002287.2","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1080\/1744666X.2025.2511265","article-title":"Dysautonomia in systemic lupus erythematosus: when to suspect and how to investigate","volume":"21","author":"Frazatto","year":"2025","journal-title":"Expert Rev Clin 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