Altered function of the hypothalamic stress axes in patients with moderately active systemic lupus erythematosus. I. The hypothalamus-autonomic nervous system axis.

OBJECTIVE

To determine the human corticotropin releasing hormone (hCRH) induced stress response of the hypothalamus-autonomic nervous system axis (HANS) in patients with moderately active systemic lupus erythematosus (SLE).

METHODS

Cardiovascular and pupillary function variables were measured by standardized computer procedures before and during an hCRH test (6 time points). The results of 12 patients with SLE were compared to 24 healthy subjects with (HS+P, n = 12) and without (HS, n = 12) prior administration of prednisolone 3 days before the test.

RESULTS

At baseline, diastolic blood pressure was significantly higher in SLE than in HS or HS+P (p<0.001). During the hCRH test, patients with SLE had increased heart rates and systolic and diastolic blood pressure responses compared to HS+P and HS (p<0.001 for all comparisons). Moreover, heart rate variation was decreased at rest, during the lying-to-standing procedure, and during the 2 applied respiratory tests (p<0.01 vs. HS). Compared to HS+P and HS, latency time of the pupillary light reflex was prolonged and maximal pupillary area was increased, revealing sympathetic hyperreactivity.

CONCLUSION

This study found an altered autonomic nervous system response at baseline, which was more pronounced during the hCRH stress test in patients with moderately active SLE compared to healthy subjects. Baseline and stress responses are characterized by a sympathetic overstimulation. Such a hypersympathetic reaction may lead to increased risk of cardiovascular diseases in patients with moderately active SLE, which needs to be investigated in longitudinal studies.