Dysautonomia and AxSpA

Dysautonomia is a group of disorders that can occur when your autonomic nervous system (ANS) is not working properly. The ANS is the part of your nervous system that controls the processes that happen automatically in the body. These include breathing, heartbeat, digestion, and more.¹

When the ANS gets disrupted, it can cause many different symptoms. The exact symptoms depend on the body system that is affected.¹

What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome, or POTS, is a type of dysautonomia. POTS causes the heart to beat very quickly when you stand up. It can also cause other symptoms like fatigue and dizziness after standing up. These symptoms can appear immediately or a few minutes after you stand up.^2,3

What causes POTS?

Doctors and researchers are still trying to figure out what causes POTS. It seems that your body’s own immune system may play a role in the development of POTS. The immune system is responsible for fighting off infections. But sometimes your immune system can begin to attack parts of your own body. This is called an autoimmune response and can lead to an autoimmune condition.^3,4

Having an infection often triggers an autoimmune condition. The infection may be a bacterial infection or viral infection like COVID-19. Up to half of people with POTS had an infection before developing POTS. So, it is possible that an infection triggers an autoimmune response, which leads to the symptoms of dysautonomia or POTS.^3,4

POTS and long COVID

POTS is becoming more common after the COVID-19 pandemic. Long COVID is diagnosed when COVID-19 symptoms last for more than 28 days. These symptoms may include symptoms of POTS. Almost one-third of people who have symptoms of long COVID also have POTS.^5,6

POTS and cardiovascular disease

Some of the symptoms of POTS are similar to the ones caused by cardiovascular disease (CVD). CVD includes health conditions that affect the heart or the blood vessels. Cardiovascular symptoms that someone with POTS may also experience include:³

• Shortness of breath
• Chest pain
• Swelling in the arms or legs
• Irregular heartbeat
• Dizziness

AxSpA and the heart

Axial spondyloarthritis (axSpA) is a type of arthritis. Ankylosing spondylitis (AS) is the type of AxSpA that causes damage that can be seen with X-rays. Both AxSpA and AS are types of autoimmune disease. This means the immune system attacks healthy cells and tissue.^6,7

The autoimmune response causes inflammation, which leads to axSpA symptoms such as pain or stiffness in the back. Many people with axSpA also develop other health conditions.^6,7

People with AxSpA are more likely to develop cardiovascular disease (CVD), or diseases that affect the heart. For example, people with AxSpA are more likely to have high blood pressure. About 12 percent of people with AxSpA develop some type of CVD.⁶

The link between AxSpA, dysautonomia, and the immune system

People with axSpA are at higher risk for developing other health conditions. A possible explanation for this risk is the overactive immune system that causes the autoimmune response. The higher risk of CVD in people with AxSpA is likely linked to this immune response.⁶

Long-term inflammation can increase your risk of developing CVD. Data show that inflammation is linked to the buildup of plaque in the arteries. This buildup can lead to different heart problems.⁶

Similarly, dysautonomia and POTS also seem to have a link to the immune system. People with AxSpA are at a higher risk for developing infections. In many cases, an infection triggers POTS. As many as 1 in every 5 people with POTS also have an autoimmune disease.³

Finally, POTS can have symptoms similar to the ones caused by CVD. And people with axSpA are more likely to develop CVD.³