{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T12:08:06Z","timestamp":1747224486072,"version":"3.40.5"},"reference-count":0,"publisher":"PAGEPress Publications","issue":"2","license":[{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reumatismo"],"abstract":"<jats:p>Sj\u00f6gren\u2019s syndrome (SS) is an autoimmune disease that involves the nervous system in about 20% of cases. In 25-92% of patients affected by Sj\u00f6gren\u2019s syndrome, neurological symptoms may precede the sicca syndrome. A 65-year-old male presented with a seven-month history of episodes of near-syncope, constipation, anhidrosis, disabling fatigue and asthenia. Physical examination was unremarkable, whilst the ECG revealed sinus bradycardia. Laboratory tests showed lymphopenia and normal inflammatory markers. In order to assess a potential autonomic neuropathy, \u201cDeep Breathing Test\u201d (E\/I 1.02), \u201cLying to Standing Test\u201d (R\/R\u2019 0.95), and \u201cOrthostatic Hypotension Tests\u201d (T 120s Systolic reduction &gt;20 mmHg and Diastolic reduction &gt;10 mmHg) were performed, all of which were abnormal. ECG Holter monitoring revealed sinus bradycardia, and right bundle branch block with 24-h blood pressure monitoring revealing a diurnal hypotensive profile. The patient reported a three-month history of worsening dry mouth. On physical examination, the patient had anisocoria in response to light stimulation. Auto-antibody testing was performed to evaluate the presence of any autoimmune disease. The results of these studies included an abnormal elevation of ANA (1:320 speckled pattern), Ro\/SS-a (&gt;240U\/l), and La\/SS-b (162 U\/ml) antibodies. The patient was discharged with a diagnosis of \u201cAutonomic Neuropathy Most Likely Due to Primary Sj\u00f6gren\u2019s Syndrome (SS)\u201d and started the immunotherapy. After one month, he reported a significant improvement in his symptoms with a concomitant normalization of his \u201cOrthostatic Hypotension Tests.\u201d This case underlines the potential for dys-autonomic symptoms to precede the onset of sicca syndrome in patients with Sjogren\u2019s Syndrome.<\/jats:p>","DOI":"10.4081\/reumatismo.2020.1241","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T04:58:43Z","timestamp":1595912323000},"page":"111-114","source":"Crossref","is-referenced-by-count":0,"title":["Pronounced dys-autonomic symptoms announcing a primary Sjo\u0308gren\u2019s syndrome"],"prefix":"10.4081","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4184-2808","authenticated-orcid":false,"given":"F.","family":"Masini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Monaco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0874-9692","authenticated-orcid":false,"given":"K.","family":"Gjeloshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1275-9079","authenticated-orcid":false,"given":"E.","family":"Pinotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Ferrrara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0310-3529","authenticated-orcid":false,"given":"P.C.","family":"Pafundi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-7805","authenticated-orcid":false,"given":"M.","family":"Santini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Salvatore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4292-3589","authenticated-orcid":false,"given":"G.","family":"Cuomo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2020,7,23]]},"container-title":["Reumatismo"],"original-title":[],"link":[{"URL":"https:\/\/reumatismo.org\/index.php\/reuma\/article\/download\/1241\/876","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/reumatismo.org\/index.php\/reuma\/article\/download\/1241\/876","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T04:58:43Z","timestamp":1595912323000},"score":1,"resource":{"primary":{"URL":"https:\/\/reumatismo.org\/index.php\/reuma\/article\/view\/1241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,23]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,7,23]]}},"URL":"https:\/\/doi.org\/10.4081\/reumatismo.2020.1241","relation":{},"ISSN":["2240-2683","0048-7449"],"issn-type":[{"type":"electronic","value":"2240-2683"},{"type":"print","value":"0048-7449"}],"subject":[],"published":{"date-parts":[[2020,7,23]]}}}