Schwemmer S, Beer P, Schölmerich J, Fleck M, Straub R H
Dept. of Internal Medicine I, University Hospital of Regensburg, Germany.
Clin Exp Rheumatol. 2006 Nov-Dec;24(6):683-9.
Patients with inflammatory diseases often demonstrate autonomic nervous dysfunction. This study was initiated to investigate cardiovascular (CAD) or pupillary autonomic dysfunction (PAD) in patients with rheumatoid arthritis (RA).
Between 1997 and 1998, 33 RA patients were examined for characteristics, and parameters of CAD and PAD. In a longitudinal part of this study, thirty patients have been re-evaluated 8.3 +/- 0.1 yr later (response rate = 91%).
A total of 18 patients (60%) demonstrated either CAD or PAD. The prevalence of CAD was 6/30 (20%) and the prevalence of PAD was 15/30 (50%). Of all cardiovascular tests, the Ewing test demonstrated the worst results (13/30 patients were below the 5th percentile). Similar as in other diseases, several RA patients demonstrated autonomic nervous hyperreflexia with values above the 95 th percentile (relative variation coefficient: 7/30; respiratory sinus arrhythmia measure: 12/30; Valsalva measure: 1/30; Ewing measure: 0/30; latency time of pupillary light reflex: 5/30; maximal pupillary area: 0/30). During the 8-year observation period, 4/30 RA patients died. Non-survivors as compared to survivors had increased heart rate variation in the respiratory arrhythmia test (p= 0.038, hyperreflexia) but largely decreased heart rate variation in the Ewing test (p= 0.009, hyporeflexia). Non-survivors as compared to survivors demonstrated more frequent pupillary autonomic dysfunction (100% vs. 42%, p= 0.035).
This study demonstrates that CAD and PAD were frequent in patients with RA. Patients with a poor test result in the Ewing test and PAD might have an increased risk of death. This study in RA patients demonstrates similar results as in patients with diabetes mellitus.
炎症性疾病患者常表现出自主神经功能障碍。本研究旨在调查类风湿关节炎（RA）患者的心血管自主神经功能障碍（CAD）或瞳孔自主神经功能障碍（PAD）。
在1997年至1998年间，对33例RA患者进行了CAD和PAD特征及参数检查。在本研究的纵向部分，30例患者在8.3±0.1年后进行了重新评估（应答率=91%）。
共有18例患者（60%）表现出CAD或PAD。CAD的患病率为6/30（20%），PAD的患病率为15/30（50%）。在所有心血管测试中，尤因测试结果最差（13/30患者低于第5百分位数）。与其他疾病类似，部分RA患者表现出自主神经反射亢进，其值高于第95百分位数（相对变异系数：7/30；呼吸性窦性心律不齐测量：12/30；瓦尔萨尔瓦动作测量：1/30；尤因测量：0/30；瞳孔对光反射潜伏期：5/30；最大瞳孔面积：0/30）。在8年观察期内，30例RA患者中有4例死亡。与幸存者相比，非幸存者在呼吸性窦性心律不齐测试中的心率变异性增加（p=0.038，反射亢进），但在尤因测试中心率变异性大幅降低（p=0.009，反射减退）。与幸存者相比，非幸存者表现出更频繁的瞳孔自主神经功能障碍（100%对42%，p=0.035）。
本研究表明，CAD和PAD在RA患者中很常见。尤因测试和PAD结果不佳的患者可能死亡风险增加。RA患者的这项研究结果与糖尿病患者相似。
