Autonomic Dysfunction In Systemic Lupus Erythematosus Patients With Previous Neuropsychiatric Involvement

Yang Gao, Sheung Wei Li, Lai Heung Chau, Chak Sing Lau and Mo Yin Mok, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Autonomic disorders, neuropsychiatric disorders and systemic lupus erythematosus (SLE)

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects II: Central Nervous System Manifestations, Therapeutics

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Autonomic dysfunction has increasingly been described to be associated with central nervous system (CNS) disorders and has been attributed to damage of the central autonomic network. In this study, we examined autonomic function among systemic lupus erythematosus (SLE) patients with previous neuropsychiatric involvement (NPSLE) compared to those without NPSLE.

Methods:

SLE patients with previous CNS involvement including seizure, acute confusion state and stroke (NPSLE), age-, sex- and disease duration- matched SLE patients (non-NPSLE) and age- and sex- matched healthy subjects were evaluated by standardized tests on sympathetic and parasympathetic functions of the cardiovascular system. Symptoms of autonomic dysfunction were screened by questionnaire.

Results:

96.0% of NPSLE and non-NPSLE patients reported one or more autonomic symptoms (24/25 for both groups) compared with 37.5% (6/16) of healthy subjects (p<0.001). Patients with NPSLE had more complaints over urinary frequency (48% vs. 20%, p=0.04) and incomplete voiding (48% vs. 12%, p=0.005) than non-NPSLE patients. They had significantly lower heart rate response to standing compared with healthy controls (1.12±0.12 vs. 1.26±0.11, p=0.003 by post hoc Tukey’s test) but not with non-NPSLE patients (1.17±0.11, p=0.44). NPSLE patients also had significantly smaller heart rate variation during deep breathing compared with non-NPSLE patients (13.1±5.3 vs. 19.5±6.1 bpm, p=0.01 by post hoc Tukey’s test). Linear regression analysis showed NPSLE as predictive factor for smaller heart rate variability during deep breathing (p=0.02) after adjustment for age. However, NPSLE was not found to have more autonomic dysfunction than non-NPSLE patients when Ewing’s criteria were applied.

Conclusion:

NPSLE patients were found to have smaller heart rate variation during deep breathing compared with non-NPSLE patients but the frequency of autonomic dysfunction was similar in both groups.

Disclosure:

Y. Gao,
None;

S. W. Li,
None;

L. H. Chau,
None;

C. S. Lau,
None;

M. Y. Mok,
None.

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