Study of autonomic nervous dysfunction among rheumatoid arthritis and systemic lupus erythematosus Egyptian patients

الملخص EN

Introduction : peripheral and central nervous system involvement have been well recognized in rheumatoid arthritis patients (RA), systemic lupus erythematous (SLE) and some other rheumatic diseases.

Autonomic nervous dysfunction has also been described, less frequently in these diseases, but its pathogenesis is still poorly understood.

Aim of work : to assess the prevalence and severity of autonomic dysfunction (AD) among RA and SLE Egyptian patients using non-invasive cardiovascular reflex tests, and to find out any possible relation between AD and the disease parameters.

Methodology : A total of 44 subjects were included in this study.

They were 16 RA and 13 SLE patients in addition to a control group of 15 apparently healthy subjects.

All subjects underwent a detailed medical history taking as well as complete general, neurological, musculoskeletal and cardiovascular examinations.

Laboratory analysis included rheumatoid factor, antinuclear antibodies and anti-ds DNA antibodies.

Cardiovascular autonomic nervous system (ANS) was assessed using standard cardiovascular reflex tests in all subjects.

Disease characteristics, co-morbid conditions, disease activity index, cardiac complaints, and drug history were also recorded.

Results : According to Ewing’s recommendations for AD classification, 4 (25 %) RA and one (7.69 %) SLE patients had normal autonomic function, while 12 (75 %) RA and 12 (92.3 %) SLE patients showed AD.

A highly significant difference was found between RA patients and the control group as well as between SLE patients and the control group for the presence of AD symptoms.

While comparing RA and SLE results, no significant difference was found between the two groups ; neither for the presence of AD symptoms nor for the results of cardiac autonomic function tests.

During our work, no correlation was found between neither the results of the index of disease activity (IDA) parameters nor mean grade of disease activity (MDAG) of RA patients and the results of cardiac autonomic function tests.

Also, no correlation was found between neither the results of clinical assessment nor the results of laboratory features of SLE patients and the results of cardiac autonomic function tests.

Conclusion : AD were common among RA and SLE patients.

Non-invasive cardiovascular reflex tests were reliable in evaluating autonomic nervous system malfunction.

Symptoms of AD should not be under-looked while evaluating patients with RA, SLE and possibly other connective tissue diseases.