Ankilozan Spondilit'te Otonomik Disfonksiyon Hastalık Sürecinin Bir İşareti midir? Bir Elektrofizyolojik Çalışma
Öz
Amaç: Bu çalışmada,
ankilozan spondilitli (AS) hastalarda klinik ve elektrofizyolojik testler
kullanarak otonom sinir sistemi (OSS) fonksiyonlarını değerlendirmeyi, hastalık
özellikleriyle ilişkiyi araştırmayı ve verileri sağlıklı bireylerle
karşılaştırmayı amaçladık.
Yöntem: Bu kesitsel
çalışmaya kırk AS hastası ve otuz sağlıklı kontrol grubu dahil edildi.
İstirahatte kalp atışı, ayakta durmaya sistolik kan basıncı gibi klinik
ölçümler alındı. OSS'nin elektrofizyolojik değerlendirmeleri sempatik cilt
yanıtı ve R-R aralık varyasyon ölçümleri ile yapıldı. Hastalık aktivitesini
tahmin etmek için Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) kullanıldı.
AS'li hastalar da iki gruba ayrıldı; BASDAI≥4 ve BASDAI <4. Gruplar
arasındaki fark ve OSS değişkenleri ile klinik özellikler arasında korelasyon
belirlendi.
Bulgular: AS hastalarının
yaş ortalaması 35,2 ± 10,4, sağlıklı kontroller 34,4 ± 11,2 idi. Hastalar
ortostatik değişimde solgunluk hissi, anormal terleme, bozulmuş bağırsak
fonksiyonlarını kontrol grubundan daha fazla olduğunu ifade etmişlerdir. Hastaların
istirahatte kalp atış hızı değerleri parasempatik disfonksiyonu gösteren
kontrol bireylerinden daha yüksekti (p = 0,001). Bir sempatik fonksiyon testi
olan ayakta durma sistolik kan basıncı yanıtı; her iki grupta da benzerdi.
Parasempatik fonksiyon testi istirahatte R–R interval variation (RRIV) ve derin nefes alma sırasında RRIV her iki
grupta benzerdi. Hasta ve kontrol grubu veya düşük ve yüksek hastalık
aktivitesi olan hastalar arasında sempatik cilt yanıtı (SCY) latans ve
amplitüdlerinde anlamlı bir fark bulunmadı (p> 0,05). SCY latansları ile CRP
seviyeleri ile hastalık süreleri arasında bir ilişki vardı.
Sonuç: OSS disfonksiyonu
semptomları AS hastalarında kontrollerden daha sık gözlendi, ancak RRIV ve SCY
ile değerlendirilen otonomik fonksiyonlarda anlamlı bir fark bulunmadı.
Anahtar Kelimeler
Ankilozan Spondilit Spondiloartrit Otonom Sinir sistemi R-R aralığı değişimi Sempatik Deri Yanıtı
Kaynakça
- 1. O'Neill T, Bresnihan B. The heart in ankylosing spondylitis. Annals of the rheumatic diseases. 1992;51:705.
- 2. Stojanovich L. Autonomic dysfunction in autoimmune rheumatic disease. Autoimmunity reviews. 2009;8:569-572.
- 3. Syngle A, Verma I, Krishan P, Garg N. Tumor necrosis factor inhibition may improve autonomic dysfunction in rheumatoid arthritis. Internet Journal of Rheumatology and Clinical Immunology. 2013;1.
- 4. Toussirot E, Bahjaoui-Bouhaddi M, Poncet J-C, Cappelle S, Henriet M-T, Wendling D, et al. Abnormal autonomic cardiovascular control in ankylosing spondylitis. Annals of the rheumatic diseases. 1999;58:481-487.
- 5. Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Apras S, Kiraz S, et al. No evidence of cardiac autonomic involvement in ankylosing spondylitis, as assessed by heart rate variability. Clinical rheumatology. 2001;20:185-188.
- 6. Borman P, Gokoglu F, Kocaoglu S, Yorgancioglu ZR. The autonomic dysfunction in patients with ankylosing spondylitis: a clinical and electrophysiological study. Clinical rheumatology. 2008;27:1267.
- 7. Laversuch C, Seo H, Modarres H, Collins D, McKenna W, Bourke B. Reduction in heart rate variability in patients with systemic lupus erythematosus. The Journal of rheumatology. 1997;24:1540-1544.
- 8. Mathias CJ, Bannister R. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system: OUP Oxford; 2013.
- 9. Camm AJ, Malik M, Bigger JT, Breithardt G, Cerutti S, Cohen RJ, et al. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. 1996.
- 10. Torun E, Gursoy E, Guler S, Kolukisa M, Tatli B. Characteristic features of migraine in schoolchildren and adolescents and its relationship with autonomic nervous system disorders. Neuropediatrics. 2013;44:252-256.
- 11. Deuschl G. Recommendations for the practice of clinical neurophysiology. guidelines of the International Federation of Clinical Neurophysiology. 1999.
- 12. Czura CJ, Friedman SG, Tracey KJ. Neural inhibition of inflammation: the cholinergic anti-inflammatory pathway. Journal of endotoxin research. 2003;9:409-413.
- 13. Guarini S, Altavilla D, Cainazzo M-M, Giuliani D, Bigiani A, Marini H, et al. Efferent vagal fibre stimulation blunts nuclear factor-κB activation and protects against hypovolemic hemorrhagic shock. Circulation. 2003;107:1189-1194.
- 14. Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000;405:458.
- 15. Martelli D, Yao S, McKinley M, McAllen R. Reflex control of inflammation by sympathetic nerves, not the vagus. The Journal of physiology. 2014;592:1677-1686.
- 16. Koopman FA, Chavan SS, Miljko S, Grazio S, Sokolovic S, Schuurman PR, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proceedings of the National Academy of Sciences. 2016;113:8284-8289.
- 17. Holman AJ, Ng E. Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Autonomic Neuroscience. 2008;143:58-67.
- 18. Koopman F, Tang M, Vermeij J, De Hair M, Choi I, Vervoordeldonk M, et al. Autonomic dysfunction precedes development of rheumatoid arthritis: a prospective cohort study. EBioMedicine. 2016;6:231-237.
- 19. Maule S, Quadri R, Mirante D, Pellerito R, Marucco E, Marinone C, et al. Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures. Clinical & Experimental Immunology. 1997;110:423-427.
- 20. Wei C-Y, Kung W-M, Chou Y-S, Wang Y-C, Tai H-C, Wei JC-C. Cardiac autonomic function in patients with ankylosing spondylitis: a case-control study. Medicine. 2016;95.
- 21. Kaya MG, Akpek M, Lam Y-Y, Dogdu O, Ardic I, Akgul O, et al. Abnormal heart rate recovery on exercise in ankylosing spondylitis. International journal of cardiology. 2013;169:215-218.
- 22. Gunay T, Yilmaz O, Bodur H. Autonomic functions and their relations with disease activity in ankylosing spondylitis. Acta Reumatol Por. 2012;37:234-239.
Is Autonomic Dysfunction a Sign of Disease Process in Ankylosing Spondylitis? An Electrophysiological Study
Öz
Objective: In this study, we aimed to evaluate autonomic nervous system
(ANS) functions by using clinical and electrophysiological tests in patients
with ankylosing spondylitis (AS), to investigate the relationship with the
disease characteristics and to compare the data with healthy individuals.
Methods: Forty AS patients and 30 healthy controls were included in this
cross-sectional study. Clinical measurements including heart rate at rest,
systolic blood pressure response to standing were obtained. The electrophysiological
assessments of ANS were performed by sympathetic skin response and R–R interval
variation measurements. Bath Ankylosing
Spondylitis Disease Activity Index (BASDAI) was used to estimate the disease
activity. Patients with AS were also subdivided
into two groups; BASDAI≥4 and BASDAI<4. The difference between the groups
and correlations between ANS variables and clinical entities were determined.
Results: Mean age of AS patients were 35,2±10,4 years and healthy
controls were 34,4±11,2 years. Patients expressed feeling of faintness in
orthostatic change, abnormal sweating, disturbed bowel function more than
control subjects. The patient’s heart rate values at rest were higher than
control subjects which indicate parasympathetic dysfunction (p=0,001). As a
sympathetic function test, systolic blood pressure response to standing was
similar in both groups. The parasympathetic function test R–R interval variation
(RRIV) at rest and RRIV during deep breathing were similar in both groups. No
significant difference was found on sympathetic skin response (SSR) latencies
and amplitudes between patients and control groups or patients with low and high
disease activity (p>0,05). A
correlation was found between SSR latencies and CRP levels and disease
durations.
Conclusions: The symptoms of ANS dysfunction were observed more frequently
in AS patients than controls but no significant difference of autonomic functions
as assessed by RRIV and SSR was found.
Anahtar Kelimeler
Ankylosing Spondylitis Spondyloarthritis Autonomic Nervous system R-R interval variation Sympathetic Skin Response
Kaynakça
- 1. O'Neill T, Bresnihan B. The heart in ankylosing spondylitis. Annals of the rheumatic diseases. 1992;51:705.
- 2. Stojanovich L. Autonomic dysfunction in autoimmune rheumatic disease. Autoimmunity reviews. 2009;8:569-572.
- 3. Syngle A, Verma I, Krishan P, Garg N. Tumor necrosis factor inhibition may improve autonomic dysfunction in rheumatoid arthritis. Internet Journal of Rheumatology and Clinical Immunology. 2013;1.
- 4. Toussirot E, Bahjaoui-Bouhaddi M, Poncet J-C, Cappelle S, Henriet M-T, Wendling D, et al. Abnormal autonomic cardiovascular control in ankylosing spondylitis. Annals of the rheumatic diseases. 1999;58:481-487.
- 5. Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Apras S, Kiraz S, et al. No evidence of cardiac autonomic involvement in ankylosing spondylitis, as assessed by heart rate variability. Clinical rheumatology. 2001;20:185-188.
- 6. Borman P, Gokoglu F, Kocaoglu S, Yorgancioglu ZR. The autonomic dysfunction in patients with ankylosing spondylitis: a clinical and electrophysiological study. Clinical rheumatology. 2008;27:1267.
- 7. Laversuch C, Seo H, Modarres H, Collins D, McKenna W, Bourke B. Reduction in heart rate variability in patients with systemic lupus erythematosus. The Journal of rheumatology. 1997;24:1540-1544.
- 8. Mathias CJ, Bannister R. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system: OUP Oxford; 2013.
- 9. Camm AJ, Malik M, Bigger JT, Breithardt G, Cerutti S, Cohen RJ, et al. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. 1996.
- 10. Torun E, Gursoy E, Guler S, Kolukisa M, Tatli B. Characteristic features of migraine in schoolchildren and adolescents and its relationship with autonomic nervous system disorders. Neuropediatrics. 2013;44:252-256.
- 11. Deuschl G. Recommendations for the practice of clinical neurophysiology. guidelines of the International Federation of Clinical Neurophysiology. 1999.
- 12. Czura CJ, Friedman SG, Tracey KJ. Neural inhibition of inflammation: the cholinergic anti-inflammatory pathway. Journal of endotoxin research. 2003;9:409-413.
- 13. Guarini S, Altavilla D, Cainazzo M-M, Giuliani D, Bigiani A, Marini H, et al. Efferent vagal fibre stimulation blunts nuclear factor-κB activation and protects against hypovolemic hemorrhagic shock. Circulation. 2003;107:1189-1194.
- 14. Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000;405:458.
- 15. Martelli D, Yao S, McKinley M, McAllen R. Reflex control of inflammation by sympathetic nerves, not the vagus. The Journal of physiology. 2014;592:1677-1686.
- 16. Koopman FA, Chavan SS, Miljko S, Grazio S, Sokolovic S, Schuurman PR, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proceedings of the National Academy of Sciences. 2016;113:8284-8289.
- 17. Holman AJ, Ng E. Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Autonomic Neuroscience. 2008;143:58-67.
- 18. Koopman F, Tang M, Vermeij J, De Hair M, Choi I, Vervoordeldonk M, et al. Autonomic dysfunction precedes development of rheumatoid arthritis: a prospective cohort study. EBioMedicine. 2016;6:231-237.
- 19. Maule S, Quadri R, Mirante D, Pellerito R, Marucco E, Marinone C, et al. Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures. Clinical & Experimental Immunology. 1997;110:423-427.
- 20. Wei C-Y, Kung W-M, Chou Y-S, Wang Y-C, Tai H-C, Wei JC-C. Cardiac autonomic function in patients with ankylosing spondylitis: a case-control study. Medicine. 2016;95.
- 21. Kaya MG, Akpek M, Lam Y-Y, Dogdu O, Ardic I, Akgul O, et al. Abnormal heart rate recovery on exercise in ankylosing spondylitis. International journal of cardiology. 2013;169:215-218.
- 22. Gunay T, Yilmaz O, Bodur H. Autonomic functions and their relations with disease activity in ankylosing spondylitis. Acta Reumatol Por. 2012;37:234-239.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Aralık 2019 |
| Gönderilme Tarihi | 23 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 9 Sayı: 4 |
SMJ'de yayınlanan makaleler, Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı kapsamında lisanslanır