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New in Rheumatoid Arthritis

Autonomic Neuroscience

Available online 13 September 2017

Cardiovascular autonomic regulation, inflammation and pain in rheumatoid arthritis

https://doi.org/10.1016/j.autneu.2017.09.003

 

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory condition characterised by reduced heart rate variability (HRV) and increased pain.

Animal studies have demonstrated reciprocal relationships between parasympathetic activity and inflammatory cytokines, however this has not been assessed in humans with RA.

This is the first study to demonstrate that in RA low HRV was associated with increased serum inflammatory cytokine concentrations, and independently associated with increased reported pain.

  • In our patients with RA, reductions in HRV were not compounded by the presence of hypertension.

Abstract

Background

Rheumatoid arthritis (RA) is a chronic inflammatory condition characterised by reduced heart rate variability (HRV) of unknown cause. We tested the hypothesis that low HRV, indicative of cardiac autonomic cardiovascular dysfunction, was associated with systemic inflammation and pain. Given the high prevalence of hypertension (HTN) in RA, a condition itself associated with low HRV, we also assessed whether the presence of hypertension further reduced HRV in RA.

Methods

In RA-normotensive (n = 13), RA-HTN (n = 17), normotensive controls (NC; n = 17) and HTN (n = 16) controls, blood pressure and heart rate were recorded. Time and frequency domain measures of HRV along with serological markers of inflammation (high sensitivity C-reactive protein [hs-CRP], tumour necrosis factor-α [TNF-α] and interleukins [IL]) were determined. Reported pain was assessed using a visual analogue scale.

Results

Time (rMSSD, pNN50%) and frequency (high frequency power, low frequency power, total power) domain measures of HRV were lower in the RA, RA-HTN and HTN groups, compared to NC (p = 0.001). However, no significant differences in HRV were noted between the RA, RA-HTN and HTN groups. Inverse associations were found between time and frequency measures of HRV and inflammatory cytokines (IL-6 and IL-10), but were not independent after multivariable analysis. hs-CRP and pain were independently and inversely associated with time domain (rMMSD, pNN50%) parameters of HRV.

Conclusions

These findings suggest that lower HRV is associated with increased inflammation and independently associated with increased reported pain, but not compounded by the presence of HTN in patients with RA.

Corresponding author at: College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

© 2017 Published by Elsevier B.V.

 

1 Response to "New in Rheumatoid Arthritis"

Andrew Carmichael

7th December 2017 at 7:46 pm

In the cases of RA that have trialed the use of E-304 (palmitoyl ascorbate) at ~2.4gm / day most have experienced freer movement, less or no pain and reduced swelling.

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