Complex syndromes of chronic pain, fatigue and cognitive impairment linked to autoimmune dysautonomia and small fiber neuropathy.

Abstract

Chronic fatigue syndrome, postural orthostatic tachycardia syndrome, complex regional pain syndrome and silicone implant incompatibility syndrome are a  subject of debate among clinicians and researchers. Both the pathogenesis and  treatment of these disorders require further study. In this paper we summarize  the evidence regarding the role of autoimmunity in these four syndromes with  respect to immunogenetics, autoimmune co-morbidities, alteration in immune cell  subsets, production of autoantibodies and presentation in animal models. These  syndromes could be incorporated in a new concept of autoimmune neurosensory  dysautonomia with the common denominators of autoantibodies against G-protein  coupled receptors and small fiber neuropathy. Sjogren's syndrome, which is a  classical autoimmune disease, could serve as a disease model, illustrating the  concept. Development of this concept aims to identify an apparently autoimmune  subgroup of the disputable disorders, addressed in the review, which may most  benefit from the immunotherapy.