Extended report
Abnormal autonomic cardiovascular control in ankylosing
spondylitis
Eric Toussirota, Malika Bahjaoui-Bouhaddib, Jean-Cyril Ponceta, Sylvie Cappelleb, Marie-Thérèse Henrietb, Daniel Wendlinga, Jacques Regnardb
a Department of
Rheumatology, Centre Hospitalier Universitaire J Minjoz, Boulevard
Fleming, 25030 Besançon Cédex, France, b Explorations Fonctionnelles Rénales et
Métaboliques. Centre Hospitalier Universitaire J Minjoz, Besançon,
France
Correspondence to: Dr E Toussirot.
Accepted for publication 30 March 1999.
OBJECTIVE
This study
was aimed at assessing the contribution of the autonomic nervous system
to adjustments of cardiovascular function in patients with ankylosing
spondylitis (AS).
METHODSIn 18 AS
patients (mean age: 34.9; mean disease duration: 6.4 years) and 13 healthy controls (mean age: 31.7) the changes of heart rate (HR) with
deep breathing (E/I ratio) and standing up (30/15 ratio) were recorded.
The slope of cardiac baroreflex, the times series of blood pressure and
HR values upon lying and standing, and venous plasma concentrations of
catecholamines were also analysed. Erythrocyte sedimentation rate
(ESR), plasma C reactive protein (CRP) concentration and a clinical
index (BASDAI score) were used to assess the degree of disease activity
in patients.
RESULTSIn the
standing patients, blood pressure was found to decrease progressively
(p< 0.001). Furthermore, the patients with a BASDAI score > 5 had a
higher heart rate than patients with a BASDAI score < 5 (p<0.02), and
there was a trend for a similar difference when patients were
classified according to their ESR and CRP. Plasma catecholamine
concentrations and the E/I ratio were not different in patients from
controls. The 30/15 ratio and the slope of the spontaneous baroreflex
during standing were both lower in AS patients than controls (p<
0.01).
CONCLUSIONSThis study
demonstrated a change in autonomic nervous system function of AS
patients, with a decreased parasympathetic activity, as evidenced by
higher HR and lower baroreflex slope. As these significant deviances
were mainly observed in patients with more active (or more
inflammatory) disease, the autonomic nervous system involvement could
be related to the inflammatory process. This autonomic strain may be
related to the cardiac involvement in AS patients.
© 1999 by Annals of the Rheumatic Diseases
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