JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v5i1.2411 jpsim.v5i1.2411 Original Research Frequency of Autonomic Neuropathy in Patients with Rheumatoid Arthritis Rathore Rabia Rab Saif ur Butt Nasir Farooq Latif Hina Noor Heba Tul Iqbal Adil Department of Medicine, KEMU, Lahore Shaukat Khanum Memorial Cancer Hospital,Lahore 28 02 2024 2024 5 1 407 412 21 10 2023 14 12 2023 Copyright © 2024 The Author(s) 2024 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To assess the frequency of autonomic neuropathy (AN) in patients with rheumatoid arthritis.

 Methodology

This Cross sectional study was carried out at Department of Medicine, Mayo Hospital, Lahore, Pakistan, from March 2020 to February 2022. A total of 100 patients were registered in the study through Outpatient Department of Medicine, Mayo Hospital, Lahore. To assess cardiac autonomic neuropathy, the five cardiovascular reflex examinations listed by Ewing were performed that includes the effect of deep breathing, Valsalva maneuver as well as standing on the measurement of heart rate (HR),also blood pressure (BP) response to sustained handgrip and standing was noted. Grading of the cardiac AN was carried out in accordance with Agarwal D et al's description.

 Results

The mean age of patients was 44.09 ± 10.06 years. There were 29 (29%) males and 71 (71%) females. The mean duration of disease was 7.88 ± 1.76 years with minimum duration of 5.5 years and maximum duration of 11 years. A total of 77 (77%) cases had autonomic neuropathy while rest of 23 (23%) cases did not have autonomic neuropathy. There were 23 (23%) cases who had mild, 32 (32%) had moderate and 16 (16%) cases had severe autonomic neuropathy.

 Conclusion

It is concluded that more than in the 3rd quarter i.e. 77% cases of RA had Autonomic Neuropathy.

 Keywords : RheumatoidArthritis Autonomicdysfunction Chronic inflammatorydisorder Extra-articularmanifestations. References Smith MH, Berman JR. What is rheumatoid arthritis? JAMA. 2022;327(12):1194. Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Prim Care. 2018;45(2):237-55. van der Woude D, van der Helm-van AH. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2018;32(2):174-87. Vegas LP, Drouin J, Dray-Spira R, Weill A. Prevalence, mortality, and treatment of patients with rheumatoid arthritis: A cohort study of the French National Health Data System, 2010–2019. Joint Bone Spine. 2023;90(1):105460. Hupin D, Sarajlic P, Venkateshvaran A, Fridén C, Nordgren B, Opava CH, et al. Cardiovascular autonomic function changes and predictors during a 2-year physical activity program in rheumatoid arthritis: a PARA 2010 substudy. Front Med (Lausanne). 2021; 10.3389/fmed.2021.788243 Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L. Autonomic impairment in rheumatoid arthritis. Int J Rheum Dis. 2012;15(4):419-26. Jahan K, Begum N, Ferdousi S. Autonomic Neuropathy in Rheumatoid Arthritis: Relationship with seropositivity of Rheumatoid factor and disease activity. J Bngladesh Soc Physiol 2021;16(2): 70-76 Chen J, Norling LV, Cooper D. Cardiac dysfunction in rheumatoid arthritis: the role of inflammation. Cells. 2021;10(4):881. Aggarwal D, Singla S. Prevalence of Autonomic Neuropathy in Patients of Rheumatoid Arthritis and Its Correlation with Disease Severity. J Clin Diag Res. 2017;11(4):OC09. Maule S, Quadri R, Mirante D, Pellerito A, Marucco E, Marnone C, et al. Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures. Clin Exp Immunol. 1997;110(3):423-7. Louthrenoo W, Ruttanaumpawan P, Aramrattana A, Sukitawut W. Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus. Q J Med. 1999; 92:97-102. Adlan AM, Lip GY, Paton JF, Kitas GD, Fisher JP. Autonomic function and rheumatoid arthritis—A systematic review. Semin Arthritis Rheum. 2014 Dec;44(3):283-304. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham III CO et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed). 1982;285(6346):916-8. Okutucu S, Akdogan A. Cardiac Autonomic Dysfunction in Rheumatoid Arthritis: Importance of Comorbidities and Medications. J Clin Rheumatol. 2021;27(2):e44. Kenney MJ, Ganta CK. Autonomic nervous system and immune system interactions. ComprPhysiol. 2014; 4(3): 1177–1200. Syngle V, Syngle A, Garg N, Krishan P, Verma I. Predictors of autonomic neuropathy in rheumatoid arthritis. Auton Neurosci. 2016;201:54-59. Peçanha T, de Andrade Lima AH. Inflammation and cardiovascular autonomic dysfunction in rheumatoid arthritis: a bidirectional pathway leading to cardiovascular disease. J Physiol. 2017; 595(4): 1025-6. Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The link between autonomic nervous system and rheumatoid arthritis: from bench to bedside. Front Med (Lausanne). 2020; 7: 589079. Thulaseedharan NK, Raj A, Zubaida PA. Cardiac Autonomic Neuropathy in Rheumatoid Arthritis. International Journal of Current Medical And Applied Sciences, 2021;31(1), 01-7. Nejad ZJ, Jamshidi AR, Qorbani M, Ravanasa P. Cardiovascular autonomic neuropathy in rheumatoid arthritis assessed by cardiovascular autonomic function tests: A cross-sectional survey Anatol J Cardiol. 2015;15(9):722-6.