Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance is found in rheumatoid arthritis (RA). Heart Rate Variability (HRV) analysis is an important tool for assessment of autonomic nerve activity. Objective: To assess cardiac autonomic nerve function status in patients with Rheumatoid arthritis (RA) by time domain measures of HRV. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2010. Sixty female RA patients, age range 18-50 years were constituted study group enrolled from the Out-patient Rheumatology Wing, Department of Medicine, BSMMU. Age matched thirty apparently healthy females were studied as control. Time domain measures of Heart Rate Variability (HRV) such as Mean RR intervals, Mean HR, SDNN, RMSSD, NN50% and PNN 50% were recorded for 5 minutes by a Polygraph machine to observe cardiac autonomic nerve function activity. Data were analyzed by independent sample t test. Results: Mean R-R interval, SDNN, RMSSD, PNN50%, NN50% were significantly lower (p<0.001) but heart rate was significantly (P<0.001) higher in rheumatoid arthritis patients. Conclusion: Cardiac autonomic nerve function is impaired and characterized by reduced resting parasympathetic activity in female Rheumatoid Arthritis patients.

Background: Association of increased cardiovascular morbidity and higher sympathetic activity in patients with Rheumatoid arthritis (RA) has been recognized. Heart rate variability (HRV) is a useful measure to assess sympatho-vagal balance. Objective: To assess autonomic nerve function status in patients with Rheumatoid Arthritis (RA) by HRV analysis. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2010. Sixty female RA patients aged 18-50 years were included in the study group. They were enrolled from the Out Patient Department of Rheumatology Wing of the Department of Medicine, BSMMU, Dhaka. For comparison age matched thirty apparently healthy females were also studied as control. The HRV parameters were recorded by a Polyrite machine. For statistical analysis independent sample t test was used. Results: Mean resting pulse rate, diastolic blood pressure and mean systolic blood pressure were higher in rheumatoid arthritis patients in comparison to those of healthy control. Mean values of LF power, LF norm and LF/ HF were significantly higher (p<0.001) & TP and HF power, HF norm were significantly lower (p<0.001) in RA patients in comparison to those of healthy control. Conclusion: This study may conclude that sympathetic activity was higher with lower parasympathetic activity along with shifting of sympathovagal balance towards sympathetic predominance in patients with rheumatoid arthritis.

Background: Sudden cardiac death in patients with Rheumatoid Arthritis has been attributed to the decreased vagal drive to the heart. Objective: To assess cardiac parasympathetic nerve function status in patients with Rheumatoid Arthritis (RA). Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2010. Sixty female RA patients aged 18-50 years were included in the study group. They were enrolled from the Out Patient Department of Rheumatology Wing of the Department of Medicine, BSMMU, Dhaka. For comparison age matched thirty apparently healthy females were also studied as control. To assess parasympathetic nerve function status, all the subjects were examined by three noninvasive cardiovascular reflex tests such as heart rate response to valsalva maneuver (valsalva ratio), heart rate response to deep breathing and heart rate response to standing (30 th :15 th ratio). For statistical analysis independent sample t test was used. Results: Mean values of valsalva ratio, deep breathing test and 30 th :15 th ratio were significantly (p<0.001) lower in rheumatoid arthritis patients compared to those of healthy control. Conclusion: From this study it may be concluded that lower cardiac parasympathetic nerve activity characterized the autonomic nerve dysfunction in patients with Rheumatoid Arthritis.

Background: Autonomic neuropathy (AN) has been recognized as a strong predictor of sudden cardiac death in Rheumatoid Arthritis (RA). Autonomic neuropathy may be assessed by five cardiovascular reflex tests. Objective: To find out the prevalence and severity of AN in RA and also to assess the correlation of inflammatory markers, disease severity and serological factor, Rheumatoid factor (RF) with autonomic reflex test parameters. Method: This cross sectional study was conducted on sixty (60) female RA patients, age range 18-50 years enrolled from the Out- Patient Department of Rheumatology Wing, Department of Medicine, of Bangabandhu Sheikh Mujib Medical University (BSMMU). Age matched 30 apparently healthy females were control. Cardiac autonomic reactivity was assessed by five cardiovascular reflex tests as described by Ewing include heart rate response to standing, deep breathing, valsalva maneuver and blood pressure response to standing and sustained hand grip. Inflammatory activity in RA was assessed by serum rheumatoid factor (RF)level which was estimated by the latex agglutination test ,C-reactive protein(CRP) and ESR and marker of disease activity was assessed by Disease activity score(DAS- 28 score) value. For statistical analysis, independent sample ‘t’ test chi-square test, pearson correlation coefficient test, spearman correlation test were used. Results: Among 60 RA patients, 43 (71.6%) patients were RF positive. Frequency of AN in RA patients was significantly higher (p< 0.001) compared to control. AN was detected in 78% of RA patients. Among the RA patients 17.38% showed severe,13.04% showed definite, 54.35% showed early involvement and 17.38% showed evidence of atypical pattern of AN. In addition, valsalva ratio and difference between maximum and minimum heart rate during deep breathing showed significant(p<0.05) negative correlation with autoantibody Rheumatoid factor(RF) whereas no significant correlation of autonomic nerve reactivity parameters with DAS- 28, CRP and ESR were found. Conclusion: Autonomic neuropathy was associated with RA. Autonomic neuropathy may be related to the presence of autoantibody RF in RA patients. J Bngladesh Soc Physiol 2021;16(1): 70-76