U. Abrahamovych

Danylo Halytsky Lviv National Medical University

Introduction. Vegetative disorders are a term that unites varieties of origin and manifestations of the violation of vegetative functions of the organism, which are caused by the disorders of their neurogenic regulation. Regarding the pathogenesis of the autonomic nervous system (NS) dysfunction in the presence of systemic lupus erythematosus (SLE), there are several hypotheses: the occurrence of vasculitis with the involvement of vessels of the nerves, or secondary amyloidosis; the influence of immunological factors, in particular, circulating antibodies to the structures of the NS were detected. However, none of them has a definitive confirmation.

The aim of the study was to describe the autonomic NS state in the patients with SLE with the different activity degree of the disease according to the heart rate variability indices.

Materials and methods. 83 patients were examined. Among them, 65 women (78.3%) and 18 men (21.7%) aged 18 to 74 years (mean age 44.2 years), who were diagnosed with SLE according to the criteria of the American College of Rheumatologists (1982, 1997). Patients are divided into three groups according to the randomized principle with pre-stratification on the activity of the pathological process of the underlying disease – SLE at the time of the heart rate variability (HRV) conducting: the first group – with the first degree of activity, the second group – with second degree of activity, the third group – with the third degree of activity. There were also 40 practically healthy persons (27 women (67.5%) and 13 men (32.5%)) aged 19-70 years old (mean age 41.8 ± 4.2 years), of which the control group was formed. Recording of the HRV was performed for 5 minutes in the lying position (state to the physical activity) and for 6 minutes in standing position (after physical activity, orthostatic test).

Results. The value of the heart rate allows to characterize the balance between the tone of the sympathetic and parasympathetic parts of the autonomic NS, since the change in the heart rate is a universal reaction of the organism to various stimuli of the internal or external environment. The state of the autonomic NS in patients with SLE with varying degrees of activity is characterized by a decrease in the total activity of vegetative effects on the heart rhythm due to the reduction of sympathetic and parasympathetic effects, as well as the humoral component.

Conclusions. Based on the reduced total spectral power in patients with SLE, an unbalance of the autonomic NS is observed due to the predominance of the sympathetic NS, especially expressed in the sample before the physical activity.

References

1. Grigorieva ZE, Avramenko NF, Kolbina IV, Polivoda SV. Analysis of Heart Rate Variability in Clinical Practice. Zaporizhzhia Medical Journal. 2005;1:96-100. (Ukrainian).
2. Korkushko OV, Pisaruk AV, Shatilo VB et al. Analysis of Heart Rate Variability in Clinical Practice (Age Aspects). Kyiv: Institute of Gerontology, Academy of Medical Sciences of Ukraine, 2002. 191 p. (Ukrainian).
3. Bayevsky RM. Analysis of Heart Rate Variability: History and Philosophy, Theory and Practice. Clinical Informatics and Telemedicine. 2004;1:54-64. (Russian).
4. Vain AM, Voznesenskaya TG, Vorobyova OV et al. Vegetative Disorders: Clinics, Diagnosis, Treatment. In: Vain AM, editor. Moskow: LLC “Medical News Agency”, 2003. 752 p. (Russian).
5. Novikova DS, Popkova ТV, Lisitsyna TA, Nasonov EL. Prospects for the Determining of Heart Rate Variability in Cases of Rheumatoid Arthritis and Systemic Lupus Erythematosus. Herald of Russian Academy of Medical Sciences. 2009;9:23-24. (Russian).
6. Rodionov A. Clinical Significance of Heart Rate Variability Study. Sechenov IM. MMA [Internet]. Available form: http://www.medicus.ru/cardiology/spec/?cont=article&art_id=947). (Russian).
7. Alexandrov AV, Alekhina IY, Sushchuk EA et al. The Role of Autoantibodies Against the Antioxidant Enzymes in the Nervous System Injury in Patients with Systemic Lupus Erythematosus. Clinical Neurology. 2009;3:10-14. (Russian).
8. Shalimar, Handa R, Deepak KK, Bhatia M, Aggarwal P, Pandey RM. Autonomic dysfunction in systemic lupus erythematosus. Rheumatol Int. 2006;9:837-840. https://doi.org/10.1007/s00296-005-0093-0
9. Altomonte L, Mirone L, Zoli A, Magaro M. Autonomic nerve dysfunction in systemic lupus erythematosus: evidence for a mild involvement. Lupus. 1997;6(5):441-444. https://doi.org/10.1177/096120339700600505
10. Bruyn GAW. Controversies in lupus: nervous system involvement. Ann Rheum Dis. 1995;54:159-167. https://doi.org/10.1136/ard.54.3.159
11. Milovanović B, Stojanović L, Milićevik N, Vasić K, Bjelaković B, Krotin M. Cardiac autonomic dysfunction in patients with systemic lupus, rheumatoid arthritis and sudden death risk. Srp Arh Celok Lek. 2010;138(1-2):26-32.
12. Aydemir M, Yazisiz V, Basarici I, Avci AB, Erbasan F, Belgi A et al. Cardiac autonomic profile in rheumatoid arthritis and systemic lupus erythematosus. Lupus. 2010;19(3):255-261.
    https://doi.org/10.1177/0961203309351540
13. Louthrenoo W, Ruttanaumpawan P, Aramrattana A, Sukitawut W. Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus. QJM. 1999;92(2):97-102. https://doi.org/10.1093/qjmed/92.2.97
14. Harris EN, Gharavi AE, Hughes GRV. Anti-phospholipid antibodies. Clin Rheum Dis. 1985;11:591-609.
15. Stein KS, McFarlane IC, Goldberg N, Ginzler EM. Heart rate variability in patients with systemic lupus erythematosus. Lupus. 1996;5(1):44-48.
16. Martínez-Lavín M, León A, Pineda C, Amigo MC, Hermosillo AG. The dysautonomia of fibromyalgia may simulate lupus. J Clin Rheumatol. 1999;6:332-334. https://doi.org/10.1097/00124743-199912000-00006