THE STUDY OF AUTONOMIC FUNCTION TESTS IN PATIENTS OF RHEUMATOID ARTHRITIS BY CARDIOVASCULAR ANALYSIS SYSTEM

Background and objectives: In patients of Rheumatoid Arthritis (RA) although peripheral and central nervous system involvement has been well recognized1 , autonomic nervous system (ANS) involvement has rarely been studied and has shown conflicting results. This study was conducted to investigate ANS dysfunction in patients of RA by CANWin using classical Ewing autonomic battery tests. Methods: 50 patients of RA between the age group of 20-70 years along with 25 healthy age and sex matched controls were evaluated by 4 parasympathetic tests including resting heart rate (HR), HR response to deep breathing, standing and valsalva maneuver; and 2 sympathetic tests consisting of blood pressure response to standing and sustained hand grip (SHG) by CANWin analysis system (Window based). Results: Heart rate response to deep breathing (E:I), standing (30:15 ratio) and valsalva showed very significant results in patients of RA as compared to that of controls (P<0.01). 10% of RA patients showed fall in systolic BP on standing by more than 20 mm Hg as compared to controls (0%) with significant p-value of <0.05. 20% of RA patients showed abnormal low rise in diastolic BP on SHG with significant p-value of <0.05. Interpretation & Conclusions: This study has confirmed the presence of cardiac autonomic nervous system dysfunctions including both sympathetic and parasympathetic, in patients of RA.