Background/Purpose:

Autonomic (AN) function is impaired in rheumatoid arthritis (RA) and is a significant risk predictor of sudden cardiac death. However, even half a century after the description of AN dysfunction in rheumatic diseases, we do not know the impact of disease modifying anti-rheumatic diseases (DMARDs). There is need to study the effect of different DMARDs which are routinely employed in the treatment of RA, So we examined the clinical efficacy of DMARDs on AN function in patients with RA.

Methods:

We evaluated total 30 RA patients of which 20 were DMARDs naïve; 9 Rheumatoid Factor (RF) RF +ve and 11 RF –ve ; mean age 40.5± 7.1 years; disease duration 5.37±6.8; 11/9 (F/M) and 10 biologics naïve; 6 RF +ve and 4 RF -ve; mean age 49.28±6.62; disease duration 9.5±5.1; 4/8 (F/M). 20 aged matched healthy subjects aged 26-57 years were also enrolled as control group. AN function was assessed by applying a battery of 5 non invasive cardiovascular reflex tests according to Ewing and peripheral sympathetic AN function was assessed by Sudoscan. CAN is considered to exist if at 2 two of 5 cardiovascular reflex tests were positive.

Results:

Patients with RA had significantly impaired AN function tests compared with healthy controls. After 12 weeks treatment with combination synthetic DMARDs, heart rate (HR) response to standing in RA patients significantly improved. After treatment with different biologic DMARDs there was significant improvement in HR responses to the deep breathing (p<0.05), standing up (p<0.05) and sustained handgrip ((p<0.05)) and sudomotor function (p<0.05). DMARDs naïve RF +ve patients had more CAN [77% (7/9)] as compared to the RF -ve patients [45.4% (5/11)].  83 % (5/6) biologics naïve RF +ve and 75% (2/3)     RF –ve patients had CAN. 44% (4/9) DMARDs naïve RF +ve patients and 18 % (2/11)      RF –ve had sudomotor dysfunction. 66.6% (4/6) biologics naïve RF +ve patients had sudomotor dysfunction while there was no sudomotor dysfunction in RF –ve patients.  After 12 weeks treatment with csDMARDs 28% (2/7) RF +ve patients and 20% (1/5) RF–ve  patients improved CAN. After treatment with biologic DMARDs, 100% (5/5) RF +ve patients and 66.6% (2/3) RF –ve patients had significantly improved CAN. 75 % (3/4) of the biologics naïve RF +ve patients who had sudomotor dysfunction improved significantly with biologics. There was no significant improvement in sudomotor function in RF +ve and       RF–ve DMARDs naïve RA patients. Patients with normal AN function had no change in their autonomic function after treatment with synthetic or biologic DMARDs.

Conclusion:

Synthetic DMARDs significantly improved HR response to standing. Biologics DMARDs significantly improved HR response to deep breath, HR response to standing, BP response to handgrip and sudomotor function in RA biologics naïve patients.  RF +ve RA patients have more AN dysfunction than RF –ve patients. In this study biologics and csDMARDs improve CAN & sudomotor function but RF +ve biologics naïve RA patients achieved significantly greater reductions in AN dysfunction compared to RF –ve biologics naïve patients.

Supported by a fellowship Grant  from Indian Government  [University Grant Commission, New Delhi (India) No. F.10-1/2008(SA-I)].

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/autonomic-dysfunction-in-rheumatoid-arthritis-improves-with-disease-modifying-anti-rheumatic-drugs/