To assess the incidence, and pattern of autonomic dysfunction in Iraqi systemic lupus erythematosus (SLE) patients and its possible association to patient’s age, duration of disease, SLE activity, drugs used &autonomic nervous system symptoms.
PATIENTS AND METHODS:
Fifty Iraqi SLE patients and 50 healthy controls were included in this study. Full history was taken and complete clinical examination was done for all individuals in both groups. Disease characteristics [age, sex, duration, SLE disease activity index (SLEDAI), drugs used, and autonomic nervous system symptoms] were also documented. Laboratory analysis included complete blood count, general urine examination, and anti-double stranded deoxyribonucleic acid. Individuals in both groups were assessed for autonomic dysfunction using 5 non-invasive tests: heart rate response to Valsalva maneuver, heart rate response to deep breathing, and heart rate response to immediate standing (30:15 ratios), systolic blood pressure response to standing and diastolic blood pressure response to sustained handgrip. Autonomic dysfunction was categorized as normal, parasympathetic, sympathetic, and mixed pattern according to criteria proposed by Ewing.
Forty three (86%) Iraqi SLE patients have autonomic dysfunction compared with 0 % of controls (p=0.00000000001) and the most common autonomic function pattern was the mixed pattern 28(56%) patients. There was no statistical significant association between autonomic function pattern and age group of patients (p=0.536). Also no statistical significant association were observed between autonomic dysfunction; and age, sex, disease duration, disease activity (SLEDAI),autonomic nervous system symptoms or drugs used (chloroquine, prednisolon, azathioprine) (p=0.434, p=0.213, p=0.405, p=0.450, p=0.069, p=0.935, p=0.204, p=0.443 respectively).
The incidence of autonomic dysfunction in Iraqi SLE patients using non-invasive tests is high (86%) and the most common pattern was the mixed pattern (56%). Also there was no statistical significant association observed between autonomic dysfunction and age, sex, duration, SLE disease activity index (SLEDAI), drugs used, and autonomic nervous system symptoms.