Tumor necrosis factor inhibition may improve autonomic dysfunction in rheumatoid arthritis
Keywords:
Tumor necrosis, dysfunction, rheumatoid arthritis, ANS, RA, ANS dysfunction, TNF-α inhibitor, TNFiAbstract
Autonomic nervous system (ANS) involvement in rheumatoid arthritis (RA) has been well recognized. Symptoms of autonomic dysfunction are absent and not specific, but diagnosis of ANS dysfunction by non-invasive means is warranted to prevent severe consequences. However, there is no study demonstrating therapeutic efficacy on autonomic neuropathy (AN) in RA. This is the first reported observation of improvement in AN with the TNF-α inhibitor (TNFi), infliximab in RA.
We report here a case of a 57-year-old, seropositive RA female with severe disease activity, investigated for AN. Non-invasive tests based on peripheral sympathetic and cardiovascular autonomic neuropathy (CAN) function were used for accurate assessment of autonomic function. The patient was treated with infliximab 3 mg/kg intravenous infusion at weeks 0, 2, and 6. An improvement in autonomic dysfunction was noted after 6 weeks of therapy in both sympathetic and parasympathetic CAN.
References
Syngle A. Arthritis and its treatment. In: Rattan S, Kassem M, ed. Prevention and treatment of age-related diseases. The Netherlands: Springer, 2006: 105–132.
Stojanovich J. Autonomic dysfunction in autoimmune rheumatic disease. Auto- immun Rev. 2009;8:569–72.
Bennett PH, Scott JT. Autonomic neuropathy in rheumatoid arthritis. Annals of Rheumatic Diseases. 1965;24:161-68.
Toussirot E, Serratrice G, Valentin P. Autonomic nervous system involvement in rheumatoid arthritis. 50 cases. J Rheumatol. 1993;20:1508–14.
Stojanovich L, Milovanovich B, Luka SR et al. Cardiovascular autonomic dysfunction in systemic lupus, rheumatoid arthritis, primary Sjögren syndrome and other autoimmune diseases. Lupus. 2007;16:181–85.
Syngle A, Verma I, Garg N, Krishan P. Autonomic Neuropathy in Psoriatic Arthritis. Clin. Rheumatol. 2013:32(7);1059-64.
Hürlimann D, Forster A, Noll G et al. Anti−Tumor Necrosis Factor-α Treatment Improves Endothelial Function in Patients with Rheumatoid Arthritis. Circulation. 2002;106:2184-87.
Syngle A, Vohra K, Sharma A, Kaur L. Endothelial dysfunction in ankylosing spondylitis improves after tumor necrosis factor-α blockade. Clin Rheumatol. 2010; 8:15-22.
Ewing DJ, Clarke BF. Autonomic Neuropathy: its Diagnosis and Prognosis. Clinics in Endocrinology and Metabolism. 1986;15:855-88.
Mayaudon H, Miloche PO, Bauduceau B. A new method for assessing sudomotor function: relevance in type 2 diabetes. Diabetes Metab. 2010; 36:450-54
Zilliox L, Peltier AC, Wren PA et al. Assessing autonomic dysfunction in early diabetic neuropathy: the Survey of Autonomic Symptoms. Neurology. 201176:1099-05.
Maule S, Quadri R, Mirante D 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, 423-27.
Altawil R, Kadetoff D, Westman M et al. A proposed mechanism for autonomic dysfunction in rheumatoid arthritis -Reduced vagal activity related to high intrathecal IL-1ß levels. Ann Rheum Dis. 2012;71 Suppl: 1A-7A.
Gonzalez JM, Mauricio D, Richart C et al. Diabetic neuropathy is associated with activation of the TNFalpha system in subjects with type 1 diabetes mellitus. Clin Endocrinol 2005; 63:525–9.
Jung CH, Kim BY, Kang SK et al. Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients. Cardiovasc Diabetol. 2012; 11:1-9.
Nikolic Vn, Jevtovic ST, Stokanovic D et al. An inverse correlation between TNF alpha serum levels and heart rate variability in patients with heart failure. J cardiol. 2013;62:37-43.
