Autonomic neuropathy-in its many guises-as the initial manifestation of the antiphospholipid syndrome.

This study investigates the connection between autonomic neuropathy and antiphospholipid syndrome, revealing that autonomic dysfunction can be the first indication of antiphospholipid syndrome. Conducted as a retrospective study of 22 patients at the University of Colorado, the research found these patients had autonomic nervous system disorders as initial symptoms, such as postural tachycardia syndrome (POTS), gastrointestinal issues, and complex regional pain syndrome. The persistence of antiphospholipid antibodies, particularly prothrombin-associated antibodies, was a crucial diagnostic marker. Notably, over half of the patients experienced thrombotic events despite mostly having low-titer antibodies. The study emphasizes the importance of recognizing this association due to its significant thrombotic risk and potential severe disability. Anecdotally, treatments with antithrombotic and intravenous immunoglobulin therapies have shown promising results in symptom management.