Bladder Pain Syndrome (BPS) is a clinical diagnosis that relies on symptoms of pain in the bladder and pelvis, including also urgency and frequency [1]. BPS has been defined as chronic (>6 months) pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency [2]. The International Continence Society (ICS) has defined BPS as the complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency, in the absence of proven urinary infection or other obvious pathology [9]. ICS, also, reserved the diagnosis Interstitial Cystitis (IC) to patients with typical cystoscopic and histological features. However, it has been shown that only a fraction of patients with BPS fulfils this definition. Apart from the relationship of BPS with overactive bladder (OAB) symptoms, there is some literature supporting a correlation of BPS with systemic diseases. In our study we investigated the possible association of BPS with autoimmune syndromes.

This is an observational comparative study including patients from the Pelvic Pain Syndrome specific outpatients’ office of the Urology Department and the Internal Medicine outpatients’ office of our hospital. Patients have been allocated into two groups. Group A included patients with BPS and an autoimmune disease in their medical history, while Group B included those with BPS but without autoimmune disease. All patients have been evaluated with visual analogue scale (VAS), Interstitial cystitis symptom index (ICSI) and Interstitial cystitis problem index (ICPI) as separate parts of O’Leary- Saint score (OSS). Additionally, all patients underwent a cystoscopy under general anesthesia in order maximum bladder capacity (MBC) to be evaluated. Patients with neurological medical history and diabetes mellitus have been excluded from the study. The collected data have been statistically analyzed with the use of SPSS v.24 and the appropriate methods for non-parametric samples.

The study enrolled 26 patients, 16 women and 10 men with a mean age of 45.5 years old. Group A included 14 patients (8 women and 6 men) and Group B 12 (8 women and 4 men). Regarding autoimmune diseases, 6 patients had rheumatoid arthritis, 4 had Sjogren Syndrome, 2 had Wilson Disease, 1 had rheumatic polymyalgia and 1 was with Lupus. In Group A the mean VAS was 8.5 for the whole patients with a prevalence for women comparing to men, documented with a statistical difference (p= 0.02). In Group B the mean VAS was 7.25 without specific differences between genders. VAS has been found statistically different between two groups (p= 0.01). Considering ICSI, patients of Group A have documented a mean score of 16.5, but there was a significant difference between genders with women to be evaluated with higher scores when compared to men (p= 0.03). In Group B, the mean ICSI was 13.25 without any difference inside genders subgroup. In parallel, the evaluation of ICPI resulted to a mean score of 12.5 for Group A with a statistical prevalence for women (p= 0.03), while the mean score for ICPI in Group B has been measured at 10.25 without difference between genders. Both indexes have been found to be statistically different comparing the two groups (p= 0.03 and p= 0.02 respectively). Inside Group A, it seemed that patients with Sjogren Syndrome documented the highest scores among all other with autoimmune diseases in the evaluation questionnaires (mean VAS= 9, mean ICSI= 17.5, mean ICPI= 13.5). Cystoscopy revealed only one case with Hunner’s lesion, in a patient with Sjogren Syndrome. Also, the mean MBC under anesthesia was 550ml for patients of Group A and 575ml for those of Group B without any statistical difference between them.

Bladder pain syndrome may have a basic research association with autoimmune diseases, but their clinical correlation has to be confirmed. In our study, patients with both BPS and autoimmune disease have been found to have more severe lower urinary tract symptoms and pain than those with BPS alone. Moreover, women seem to suffer more than men. The limitation of our study is that the difference among autoimmune diseases, regarding lower urinary tract dysfunction and pain, cannot be evaluated due to the small recruitment.

Patients with bladder pain syndrome seem to have a more severe lower urinary symptoms and discomfort when there is a medical history of a concomitant autoimmune disease.

Van De Merwe, J., Nordling, J., Bouchelouche, K. et.al: Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an essic proposal. Eur Urol, 53: 60, 2008.
Hanno, P., Nordling, J., van Ophoven, A.: What is new in bladder pain syndrome/interstitial cystitis? Curr Opin Urol, 18: 353, 2008
Abrams, P. H., Cardozo, L., Fall, M., et al.: The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourology and Urodynamics, 21: 167, 2002.