What is POTS?
POTS stands for postural orthostatic tachycardia syndrome. This condition is characterized by an abnormally fast heart rate when standing up.
The highest incidence of POTS is among women in their 20s [1].
Clinically, POTS can be diagnosed based on the head-up tilt test. If the result of this test show an increase of more than 30 beats per minute or a heartbeat faster than 120, it is suggestive of POTS [2, 3].
Among the symptoms of POTS are:
- problems with concentration,
- severe fatigue,
- palpitations,
- heaviness in the legs,
- lightheadedness [4, 5].
Also, patients with POTS can experience pre-syncope and syncope [5].
What is lupus?
Systemic lupus erythematosus is an autoimmune disorder. In this disease, the immune system produces antibodies against against the body's own tissues. The antibodies lead to systemic inflammation, causing damage to healthy tissues [6, 7].
This disease affects mostly women and has a prevalence of less than 1% [8].
Lupus can vary in severity from mild to severe. It can affect any part of the body [9].
A characteristic of lupus is periods of symptoms worsening and improvement. Among the symptoms of lupus are:
- joint pain,
- joint swelling,
- skin rashes,
- hair loss,
- ulcers in the mouth,
- fever,
- photosensitivity,
- problems with the kidneys [10, 11].
At the moment, no cure for lupus exists. The management is focused on the reduction of inflammation and symptoms [7].
Can lupus cause POTS?
Yes, lupus can lead to POTS. POTS is indeed associated with autoimmune diseases, such as lupus [12].
However, suffering from lupus does not automatically lead to POTS. Having lupus increases only the chances of getting POTS, as chronic inflammation can disturb blood pressure regulation.
How does lupus cause POTS?
The development of POTS in lupus involves autoimmune responses, inflammation, and vascular dysfunction. All these occur during lupus and increase the probability of POTS.
In systemic lupus erythematosus, antibodies are produced against the body. For example, they can target parts of the DNA structure.
These antibodies lead to a systemic autoimmune reaction that leads to tissue damage [13].
Among the affected tissues of the body can also be the cardiovascular system. The inflammation leads to the dysfunction of the endothelium. It is a crucial factor in the development of cardiovascular diseases [14].
Additionally, the activation of the immune system in POTS and the increased inflammatory markers can occur in POTS. This indicates that also POTS can have an autoimmunological background [15].
Furthermore, lupus can potentially lead to abnormal heart rate regulation [13]. This can positively influence the development of POTS.
How to prevent POTS when having lupus?
The most important thing in the prevention of POTS in lupus is the treatment of the lupus.
The management should be focused primarily on lowering the inflammation and autoimmune activity. A lower inflammation in the body can reduce the risk of POTS [16].
Additionally to the treatment of the inflammation, lifestyle can help in the potential prevention of POTS. One of the important aspects that can be helpful is stress management. Lowering the stress can include strategies like regular physical activity, good sleep, and relaxation time [17].
Also, prevention of infections, such as COVID-19, can minimize the chances of lupus exacerbation. This allows for better control of the lupus disease and minimizes the chances of POTS development [18].
Can POTS cause lupus?
At the moment, there is no scientific evidence that POTS can lead to lupus.
When you have POTS and lupus it is most likely that POTS is caused by lupus. It might be that your lupus has been active before your definitive diagnosis. Sometimes many years can pass until a definitive diagnosis of lupus. During this time, you can develop POTS.