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Rheumatology Advance Access originally published online on May 22, 2009
Rheumatology 2009 48(7):843-848; doi:10.1093/rheumatology/kep134
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cardiovascular autonomic function assessed by autonomic function tests and serum autonomic neuropeptides in Egyptian children and adolescents with rheumatic diseases

Zeinab A. El-Sayed1, Gehan A. Mostafa1, Gamal S. Aly2, Ghada S. El-Shahed3, Manal M. Abd El-Aziz4 and Safaa M. El-Emam2

1Department of Paediatrics, 2Department of Medical Studies, Institute of Postgraduate Childhood Studies, 3Department of Cardiology and 4Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Correspondence to: Gehan A. Mostafa, 9 Ahmed El-Samman Street off Makram Ebaid, Nasr City, Cairo 11511, Egypt. E-mail: hafezg{at}softhome.net


  Abstract

Objective. Cardiovascular autonomic neuropathy (CAN) in patients with rheumatic diseases may result in sudden death, possibly from arrhythmia and myocardial infarction due to its frequent association with microvascular disease. Autonomic dysfunction may contribute to initiation and perpetuation of rheumatic diseases. Thus, we aimed to assess cardiovascular autonomic function in lupus and juvenile idiopathic arthritis (JIA) patients.

Methods. Assessment of cardiovascular autonomic function was done in 20 lupus and 20 JIA patients, aged 8–16 years, by five non-invasive autonomic function tests (AFTs) and serum levels of neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP), as indicators of sympathetic and parasympathetic functions, respectively, in comparison with 40 matched healthy control subjects.

Results. Clinical evidence of CAN was found in 65 and 40% of lupus and JIA patients, respectively, and in none of healthy controls. Lupus and JIA patients had significantly lower serum NPY and VIP than controls (P < 0.001). The five AFTs score had significant negative correlations to NPY and VIP (P < 0.001). Patients with CAN had significantly lower serum NPY and VIP than patients without (P < 0.001). Clinical evidence of CAN was found in 41.7 and 14.3% of asymptomatic lupus and JIA patients, respectively. There was significant positive association between CAN and important disease manifestations, including activity, in these patients.

Conclusions. CAN is common in lupus and JIA patients, even in absence of relevant symptoms. Thus, assessments of cardiac autonomic function, by AFTs and serum autonomic neuropeptides (NPY and VIP), and the therapeutic effects of NPY and VIP are recommended in these patients.

KEY WORDS: Autonomic function tests, Autonomic nervous system, Cardiovascular autonomic neuropathy, Juvenile idiopathic arthritis, Neuropeptide Y, Systemic lupus erythematosus, Vasoactive intestinal peptide

Submitted 30 July 2008; revised version accepted 22 April 2009.
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