Department of Rheumatology, Diakonhjemmet Hospital, PB 23 Vindern, 0319 Oslo, Norway.
Department of Rheumatology, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Semin Arthritis Rheum. 2018 Aug;48(1):134-140. doi: 10.1016/j.semarthrit.2017.11.010. Epub 2017 Dec 5.
Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are inflammatory joint disorders (IJD) with increased risk of cardiovascular disease (CVD). Autonomic dysfunction (AD) is a risk factor for CVD, and parasympathetic AD is linked to key features of IJD such as inflammation, physical inactivity and pain. Heart-rate variability (HRV) is a marker of cardiac AD. The study objective was to compare parasympathetic cardiac AD, measured by HRV, between patients with IJD and healthy controls, using meta-analysis methodology, and to examine the impact of inflammation, physical inactivity and pain on HRV in IJD.
Medline, Embase and Amed were searched. Inclusion criteria were adult case-control studies published in English or a Scandinavian language, presenting HRV data in IJD. Two measures of HRV and 3 from the Ewing protocol were selected: square root of mean squared difference of successive R-R intervals (RMSSD), high frequency (HF), Ewing protocol; standing (E-S), breathing (E-B) and Valsalva (E-V). Patients with RA, SpA and healthy controls were compared separately using random-effects meta-analyses of standardized mean differences (SMD).
In all, 35 papers were eligible for inclusion. For RMSSD the pooled SMD (95% CI) RA vs. controls was -0.90 (-1.35 to -0.44), for SpA vs. controls; -0.34 (-0.73 to 0.06). For HF pooled SMD RA vs. controls was -0.78 (-0.99 to -0.57), for SpA vs. controls; -0.04 (-0.22 to 0.13). All Ewing parameters were significantly lower in cases, except for E-V which was comparable between cases and controls in patients with RA.
Patients with IJD have cardiac parasympathetic AD which is related to inflammation.
类风湿关节炎（RA）和强直性脊柱炎（SpA）是炎症性关节疾病（IJD），心血管疾病（CVD）风险增加。自主神经功能障碍（AD）是 CVD 的一个危险因素，副交感神经 AD 与 IJD 的关键特征有关，如炎症、身体活动减少和疼痛。心率变异性（HRV）是心脏 AD 的标志物。本研究的目的是使用荟萃分析方法比较 IJD 患者和健康对照组之间副交感心脏 AD，通过 HRV 测量，并探讨炎症、身体活动减少和疼痛对 IJD 中 HRV 的影响。
在 Medline、Embase 和 Amed 中进行了搜索。纳入标准为发表在英文或斯堪的纳维亚语的成人病例对照研究，提供 IJD 中的 HRV 数据。选择了 HRV 的两个测量指标和 Ewing 方案的 3 个指标：均方根差的平方根（RMSSD）、高频（HF）、Ewing 方案；站立（E-S）、呼吸（E-B）和瓦尔萨尔瓦（E-V）。使用标准化均数差（SMD）的随机效应荟萃分析分别比较 RA、SpA 和健康对照组。
共有 35 篇论文符合纳入标准。对于 RMSSD，RA 与对照组的合并 SMD（95%CI）为-0.90（-1.35 至-0.44），对于 SpA 与对照组为-0.34（-0.73 至 0.06）。对于 HF，RA 与对照组的合并 SMD 为-0.78（-0.99 至-0.57），对于 SpA 与对照组为-0.04（-0.22 至 0.13）。除 RA 患者的 E-V 外，所有 Ewing 指标均明显低于病例组，E-V 在病例组和对照组之间相当。
IJD 患者存在心脏副交感神经 AD，与炎症有关。
