Heart rate variability in patients with rheumatoid arthritis

International Journal of Innovative Research in Medical Science

Rheumatoid arthritis is common inflammatory arthritis arising throughout the world. A chronic systemic inflammatory autoimmune disorder is known as Rheumatoid arthritis (RA). Principally it affects the joints and usually accompanied by one or more of extra-articular manifestations as rheumatoid nodules, neuropathy and norm chromic normocytic anemia. Rheumatoid arthritis can start at any age, but has maximum between 35 to 55 years of age. The prevalence of RA is about 1% worldwide whereas India is 0.9% with women suffering 3-5 times more than men. Sympathetic and parasympathetic involvement has described in primary and secondary vasculitis processes, as in systemic vasculitis processes like: SLE, RA. Peripheral nervous system is the main target in RA patients where as involvement of central nervous system (CNS) is rare. The aim of this study was to evaluate cardiac autonomic function in RA and compare with healthy individuals by using HRT analysis. Materials and Methods: A cross-sect...

Indian Journal of Clinical Anatomy and Physiology, 2022

Rheumatoid arthritis (RA) is a type of inflammatory arthritis that affects people all over the world. RA is a chronic systemic inflammatory autoimmune disease. It primarily affects the joints and is frequently accompanied by extra-articular symptoms such as rheumatoid nodules, neuropathy, and normochromic normocytic anaemia. Objectives- The aim of this study was to evaluate cardiac autonomic function in patients with rheumatoid arthritis and compare with healthy individuals. An observational, cross-sectional study was done between 50 having RA & 50 normal healthy subjects not on any medication, on both males & females between the age group of 30-60 years. Evaluation of autonomic nervous system was done with the help of non-invasive tests. Parasympathetic system was assessed by heart rate response to standing & heart rate response to lying down position. Sympathetic system was assessed by blood pressure response to standing, BP response to Valsalva Maneuverer & BP response to sustain...

Journal of Bangladesh Society of Physiologist, 2012

Background: Association of increased cardiovascular morbidity and higher sympathetic activity in patients with Rheumatoid arthritis (RA) has been recognized. Heart rate variability (HRV) is a useful measure to assess sympatho-vagal balance. Objective: To assess autonomic nerve function status in patients with Rheumatoid Arthritis (RA) by HRV analysis. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2010. Sixty female RA patients aged 18-50 years were included in the study group. They were enrolled from the Out Patient Department of Rheumatology Wing of the Department of Medicine, BSMMU, Dhaka. For comparison age matched thirty apparently healthy females were also studied as control. The HRV parameters were recorded by a Polyrite machine. For statistical analysis independent sample t test was used. Results: Mean resting pulse rate, diastolic blood pressure and mean systolic blood pressure were higher in rheumatoid arthritis patients in comparison to those of healthy control. Mean values of LF power, LF norm and LF/ HF were significantly higher (p<0.001) & TP and HF power, HF norm were significantly lower (p<0.001) in RA patients in comparison to those of healthy control. Conclusion: This study may conclude that sympathetic activity was higher with lower parasympathetic activity along with shifting of sympathovagal balance towards sympathetic predominance in patients with rheumatoid arthritis.

IP Innovative Publication Pvt. Ltd., 2019

Rheumatoid Arthritis (RA) is a chronic debilitating disorder affecting the synovial joints with higher prevalence in females. Extra articular manifestations are seen in around 40% of patients with RA. The nervous system faces the brunt of RA. The autonomic nervous system imbalance leads to RA associated cardiac morbidity and mortality. Cardiac dysfunction is due to reduction in heart rate variability (HRV). HRV testing assesses sympathovagal balance and is an easily reproducible method of testing the cardiac autonomic system. Materials and Methods: A cross sectional study was conducted using 30 female patients and compared to 30 age & sex matched healthy volunteers. The participants were subjected to short term HRV recording using Multichannel Physiopac- PP8. Data was transferred to Kubios HRV version 2.0. The time domain variables including SDNN, RMSSD, mean RR and pNN50 were derived. Frequency domain variables corresponding to the parasympathetic and sympathetic activity were also assessed. Statistical analysis carried out using SPSS software 18.0. p values < 0.05 was considered statistically significant. Results: The statistical analysis show significance of NN50 and pNN50 among the time domain variables. The frequency domain variables VLF power %, LF power n.u, HF power ms2 , HF power %, HF power n.u and LF/HF ratio were significant. Conclusion: HRV analysis proves to be an easy, non-invasive, cost effective, reproducible and reliable tool for prediction of cardiac events. This tool will help the clinician to predict and fine tune treatment protocols for RA. Keywords: Frequency domain, Short term heart rate variability, Spectral analysis, Sympathovagal balance, Time domain.

Asian Journal of Sports Medicine, 2020

Background: Cardiovascular autonomic dysfunction is one of the most common complications in rheumatoid arthritis (RA), which can be assessed by heart rate variability (HRV) analysis. Because the autonomic nervous system plays an important role in orchestrating the cardiovascular response to stressors, assessing HRV during exercise is critical. The Glittre Activities of Daily Living test (GA-T) was recently proposed as a multitask field test that requires the performance of the upper and lower limbs, both of which are affected in individuals with RA. Objectives: This study was conducted to evaluate autonomic impairment by HRV in women with RA using the GA-T and to correlate these changes with physical functioning and muscle strength. Methods: This cross-sectional study enrolled 20 women (median [interquartile range]: age 55 [47.5 - 68.8] years) with RA (time since diagnosis: 15 [6.50 - 23.5] years) who underwent HRV assessment during GA-T. They also underwent physical functioning ass...

Journal of Drug Delivery and Therapeutics, 2015

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011

Journal of Bangladesh Society of Physiologist, 2015

Background: Association of increased cardiovascular morbidity and higher sympathetic activity in patients with Rheumatoid arthritis (RA) has been well recognized. Objective: To assess sympathetic nerve function status in Rheumatoid arthritis patients and its relationship to duration of the disease. Methods: This study was carried out in the dept of Physiology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during 2010.Sixty female RA patients aged 18-50 years with duration of disease from 1 to 10 years was selected from Rheumatology wing of Medicine OPD of BSMMU. Age and BMI matched female apparently healthy subjects were control. Sympathetic nerve function status was assessed by blood pressure response to orthostatic test and sustained hand grip isometric exercise test. In these two tests, fall in systolic blood pressure (SBP) and rise in diastolic blood pressure (DBP) respectively estimates sympathetic reactivity. For statistical analysis, unpaired students t test and pearsons correlation coefficient test was applied. Results: Mean values of fall of SBP was higher and rise of DBP was lower in RA patients compared to control which was statistically (P<0.001) significant. Again rise of DBP was negatively and fall of SBP was positively correlated with duration of the disease and the relationships were statistically highly significant (p<0.01). Conclusion: The results conclude that sympathetic reflex response was reduced in RA which was deteriorated with duration of disease.

Seminars in Arthritis and Rheumatism, 2014

Objectives Rheumatoid arthritis (RA) is a chronic inflammatory condition with increased allcause and cardiovascular mortality. Accumulating evidence indicates that the immune and autonomic nervous systems (ANS) are major contributors to the pathogenesis of cardiovascular disease. We performed the first systematic literature review to determine the prevalence and nature of ANS dysfunction in RA and whether there is a causal relationship between inflammation and ANS function. Methods Electronic databases (Medline, Central and Cochrane Library) were searched for studies of RA patients where autonomic function was assessed. Forty studies in total were included. ANS function was assessed by clinical cardiovascular reflex tests (CCTs)(n=18), heart rate variability (HRV)(n=15), catecholamines (n=5), biomarkers of sympathetic activity (n=5), sympathetic skin responses (n=5), cardiac baroreflex sensitivity (cBRS) (n=2) and pupillary light reflexes (n=2). 9 small studies reported a ~60% (median, range 20-86%) prevalence of ANS dysfunction (defined by abnormal CCTs) in RA. 73% of studies (n=27/37) reported at least one abnormality in ANS function: parasympathetic dysfunction (n=20/26, 77%), sympathetic dysfunction (n=16/30, 53%) or reduced cBRS (n=1/2, 50%). An association between increased inflammation and ANS dysfunction was found (n=7/19, 37%) although causal relationships could not be elucidated from the studies available to date. Conclusions ANS dysfunction is prevalent in ~60% of RA patients. The main pattern of dysfunction is impairment of cardiovascular reflexes and altered HRV indicative of reduced cardiac parasympathetic (strong evidence) and elevated cardiac sympathetic activity (limited evidence). The literature to date is underpowered to determine causal relationships between inflammation and ANS dysfunction in RA.

Lupus, 2010

Neurological involvement is a well-documented issue in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about the involvement of the autonomic nervous system. This study was conducted to investigate autonomic nervous system dysfunction in patients with RA and SLE. Twenty-six RA patients, 38 SLE patients and 40 healthy controls were recruited from our in-and out-patient departments. Heart rate variability (HRV) parameters (the power of the high-[HF] and low-frequency [LF] band of haemodynamic time series, the ratio between low-and high-frequency components [LF/HF ratio], the power spectral density), baroreflex sensitivity (BRS) and beat-to-beat blood pressures were assessed by a novel non-invasive haemodynamic monitoring tool (Task Force Monitor Õ [TFM], CNSystems Medizintechnik GmbH, Graz, Austria). Autonomic nervous system dysfunction was determined according to classical Ewing autonomic test battery. Furthermore, we implemented a secondary autonomic test score by modifying the Ewing test battery with additional criteria. Both the classical and modified Ewing test batteries have revealed that the frequencies of autonomic neuropathy were significantly higher in patient groups compared with controls (p < 0.001). Evaluation by TFM revealed that deterioration of sophisticated autonomic parameters (such as HRV and BRS) were more pronounced in the patient groups compared with controls. There was a significant association between BRS and Ewing test scores and abnormal BRS results were more frequent in patients with autonomic dysfunction according to Ewing test batteries. No relation was found between autonomic neuropathy and disease duration, disease activity and autoantibody positivity. Consequently, we believe that further large-scale studies investigating cardiovascular autonomic neuropathy in rheumatic diseases should be carried out to verify our findings and manifest clinical consequences beyond these results. Lupus (2010) 19, 255-261.