Sympathetic Skin Response and R-R Interval Variation in Rheumatoid Arthritis

Tan, Jale; Akın, Serhat; Beyazova, Mehmet; Sepici, Vesile; Tan, Ersin

doi:10.1097/00002060-199308000-00005

Cited by 26 publications

(18 citation statements)

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“…Although we found more widespread ACR impairment in those who were RA factor positive, there was no apparent relationship with markers of inflammatory activity. This concords with previous work in inflammatory arthritis (2,11–14).…”

Section: Discussionsupporting

confidence: 91%

The effects of age, seropositivity and disease duration on autonomic cardiovascular reflexes in patients with rheumatoid arthritis

Sandhu

Allen

2004

International Journal of Clinical Practice

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Previous studies have shown that autonomic cardiovascular reflexes (ACRs) are impaired in rheumatoid arthritis (RA) and in old age. To investigate the integrity of ACRs in patients with RA, with reference to age, duration of disease and rheumatoid factor (RF) positivity, we conducted a prospective open study of 62 RA outpatients (age 38-84) and 41 healthy controls (age 22-82) using five standard tests of ACR function. Patients of all ages with RA were found to have blunted ACRs when compared with younger controls, though this effect was subclinical. Older RA patients did not have significantly more ACR impairment than older controls. There was a tendency to greater impairment of ACRs in RA patients with a positive RF. The age-associated changes in ACRs in normal subjects are similar to those seen in RA patients of all ages. The effects of RA and age on ACRs do not appear to be additive.

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Section: Discussionsupporting

confidence: 91%

The effects of age, seropositivity and disease duration on autonomic cardiovascular reflexes in patients with rheumatoid arthritis

Sandhu

Allen

2004

International Journal of Clinical Practice

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“…64 Their study rationale has been the fact that patients with sepsis, rheumatoid arthritis, lupus, inflammatory bowel disease, and other cytokine-mediated diseases have an impaired parasympathetic tone, which could be observed through an increase in their heart rate and a decrease in their HRV. [65][66][67][68][69][70][71][72] In rheumatoid arthritis, Goldstein et al have also observed an associated macrophage activation, which was determined by measuring the levels of serum cytokines after an in vitro LPS-challenge. 64 …”

Section: The Epistemological Significancementioning

confidence: 99%

The Neuroimmune Basis of Anti-inflammatory Acupuncture

2007

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This review article presents the evidence that the antiinflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity. There is also experimental evidence that the electrical stimulation of the vagus nerve inhibits macrophage activation and the production of TNF, IL-1β β, IL-6, IL-18, and other proinflammatory cytokines. It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of traditional and electro-acupuncture are directly or indirectly mediated by the efferent vagus nerve activation and inflammatory macrophage deactivation. In view of this common physiological mediation, assessing the clinical efficacy of a specific acupuncture regimen using conventional double-blind placebo-controlled trials inherently lacks objectivity due to (1) the uncertainty of ancient rules for needle placement, (2) the diffuse noxious inhibitory control triggered by control-needling at irrelevant points, (3) the possibility of a dose-response relationship between stimulation and effects, and (4) the possibility of inadequate blinding using an inert sham procedure. A more objective assessment of its efficacy could perhaps consist of measuring its effects on the surrogate markers of autonomic tone and inflammation. The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity. Keywords

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“…There is already support for this concept in the medical literature. Patients with autoimmune diseases, including diabetes, rheumatoid arthritis and lupus, have dysfunction of the autonomic nervous system, as evidenced by a variety of tests including tilt table responses [63][64][65][66][67][68]. Other inflammatory diseases, including Crohn's disease and sepsis, are also associated with autonomic dysfunction [69][70][71].…”

Section: Autonomic Dysfunction In Inflammatory Diseasesmentioning

confidence: 99%

Autonomic neural regulation of immunity

Czura

Tracey

2005

Journal of Internal Medicine

221

163

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The 'cytokine theory of disease' states that an overproduction of cytokines can cause the clinical manifestations of disease. Much effort has been expended to determine how cytokines are regulated in normal health. Transcriptional, translational and other molecular control mechanisms protect the host from excessive cytokine production. A recent discovery revealed an unexpected pathway that inhibits macrophage cytokine production. The inflammatory reflex is a physiological pathway in which the autonomic nervous system detects the presence of inflammatory stimuli and modulates cytokine production. Afferent signals to the brain are transmitted via the vagus nerve, which activates a reflex response that culminates in efferent vagus nerve signalling. Termed the 'cholinergic anti-inflammatory pathway', efferent activity in the vagus nerve releases acetylcholine (ACh) in the vicinity of macrophages within the reticuloendothelial system. ACh can interact specifically with macrophage a7 subunits of nicotinic ACh receptors, leading to cellular deactivation and inhibition of cytokine release. This 'hard-wired' connection between the nervous and immune systems can be harnessed therapeutically in animal models of inflammatory disease, via direct electrical stimulation of the vagus nerve, or through the use of cholinergic agonists that specifically activate the macrophage a7 subunit of the ACh receptor. Autonomic dysfunction has been associated with human inflammatory diseases including rheumatoid arthritis, diabetes and sepsis; whether this dysfunction results from the inflammatory component of these diseases, or is actually an underlying cause, is now less clear. The description of the cholinergic anti-inflammatory now brings to the fore several new therapeutic strategies for inflammatory disease, and suggests that many of these diseases may actually be diseases of autonomic dysfunction.

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Sympathetic Skin Response and R-R Interval Variation in Rheumatoid Arthritis

Cited by 26 publications

References 0 publications

The effects of age, seropositivity and disease duration on autonomic cardiovascular reflexes in patients with rheumatoid arthritis

The effects of age, seropositivity and disease duration on autonomic cardiovascular reflexes in patients with rheumatoid arthritis

The Neuroimmune Basis of Anti-inflammatory Acupuncture

Autonomic neural regulation of immunity

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