Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Autonomic Nervous System Activity Upon Mental Stress in Patients with Rheumatoid Arthritis with Various Disease Activities

Malysheva,  Olga, Baum,  Petra, Voitzsch,  Anke, Baerwald,  Christoph G.


To characterize the pattern of the autonomic response to mental stress in patients with rheumatoid arthritis (RA) and healthy controls. Stress is recognized as an important risk factor in the pathogenesis of RA. However, it is still incompletely understood how the autonomic nervous system and the immune system interact in patients with RA.


Heart rate variability (HRV) test was performed in 70 RA patients with various disease activity and 100 matched healthy controls (ProSciCard III, Version 2.2a, Medi-Syst GmbH, Germany). Standard tests of autonomic nervous system function involving mental arithmetic tasks to induce mental stress were performed. HRV measures including frequency domain analysis (employing rapid processing of a 5 minute ECG rhythm strip) yielding measures of parasympathetic and sympathetic activity as well as total power (high frequency (HF), low frequency (LF), and very low frequency (VLF)) heart rate variability, variation coefficient, and square root of the mean of the squares of successive R-R interval differences (RMSSD).


Patients with RA had an impaired response to mental stress with a paradox increase of VLF HRV (2.1 ± 0.1 ×10-4 Hz at rest vs. 2.7 ± 0.2 ×10-4 Hz after stress, p < 0.05). In particular in patients with higher disease activity (DAS > 3.2 <= 5.1) VLF HRV significantly increased upon stress (1.7 ± 0.1 ×10-4 Hz at rest vs. 2.9 ± 0.1 ×10-4 Hz after stress, p < 0.01). Moreover, LF HRV, HF HRV as well as sympathetic/parasympathetic ratio did not differ significantly. However, in RA patients in remission (DAS <= 2.3) mental stress led to a significant increase of LF HRV (1.0 ± 0.1 ×10-4 Hz at rest vs. 1.5 ± 0.04 ×10-4 Hz after stress) and a tendency to an increase of LF/HF ratio. Interestingly, RA patients receiving a combination therapy of anti-TNF agents with MTX exhibited a decreased level of LF HRV at baseline compared to MTX monotherapy (1.1 ± 0.02 ×10-4 Hz vs. 1.6 ± 0.04 ×10-4 Hz, p<0,05) as well as a decreased LF/HF ratio (0.7 ± 0.02 ×10-4 Hz vs. 1.17 ± 0.14 ×10-4 Hz, p<0,001). In patients with anti-TNF combination therapy HF HRV response to mental stress was significantly increased compared to MTX monotherapy (1.4 ± 0.1 ×10-4 Hz vs. 1.9 ± 0.1 ×10-4 Hz after stress, p<0.05).


Our findings demonstrate that in RA patients the autonomic response to minor psychological stress is characterized by a reduced sympathetic activity which is associated with disease activity. Anti-TNF therapy can actively modify stress reactivity towards predominance of the parasympathetic system. Further studies are under way to determine the role of the autonomic nervous system in the disease process of RA and the modulation of neuro-immune interactions by various medications.

To cite this abstract, please use the following information:
Malysheva, Olga, Baum, Petra, Voitzsch, Anke, Baerwald, Christoph G.; Autonomic Nervous System Activity Upon Mental Stress in Patients with Rheumatoid Arthritis with Various Disease Activities [abstract]. Arthritis Rheum 2009;60 Suppl 10 :976
DOI: 10.1002/art.26053

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