AB0923 Autonomic dysfunction in psoriatic arthritis patients and psycho-emotional disorders frequency

Abstract

Background: Progressive autonomic dysfunction syndrome development is a characteristic for the most of immune inflammatory processes. Pain syndrome chronization in patients with psoriatic arthritis (PsA) is one of the leading factors contributing to the development of psycho-emotional disorders. They, in turn, exacerbate the disorders of the autonomic nervous system. Objectives: to evaluate function of the autonomic in PsA patients and the presence of psycho-emotional disorders in them Methods: 73 patients with PsA (≥5 SJC and ≥5 TJC; CRP≥0,3 mg/dL) were examined by psycho-emotional testing using the Spielberger anxiety and Hamilton depression scales. Autonomic disorders were detected by “Vein-Patient”-VP method's questionnaire, filled by the patient (when more than 15 points -autonomic dysfunction is possible (AD)) and “Vein-Doctor”-VD questionnaire, filled by the doctor (more than 25 points -confirmation of the presence of AD); studied the general indicators of heart rate variability (HRV) -mode (Mo), mode amplitude (AMo), autonomic equilibrium index (AEI), activity index of regulatory systems (AIRS); spectral characteristics -standard deviation of normal RR intervals (SDNN); square root of the mean of the sum of the squares of the differences between consecutive RR-intervals (RMSSD) and the ratio of balance between sympathetic and parasympathetic activities (LF/HF) of autonomic nervous system (ANS). All the patients received MTX in a stable dose for 6 months at least, prior the time of the study. Results: in 39 PsA patients (53,4%) increased reactive anxiety (37,0±1,5 points) and personal anxiety (45,4±1,5 points) levels were determined as results of testing. They made up the 1st observation group, and the remaining 34 patients -the 2nd observation group. In the first group, according to the questionnaire VP and VD more significant excess of the norm was defined (19.79±0.54 points and 29.8 ±0.77 points respectively) than in the 2nd group (16,92±0,62 and 27,1±0,8 points). The decrease of the SDNN RMSSD in comparison with norm was revealed in the both groups, that evidences an inhanced sympathetic regulation. However, more significant LF/HF growth (4,15±0,64) and SDNN decrease(22,4 ±5,6 ms) in the 1st group, than in the 2-nd (3,0±0,86; 29,1±8,4 ms, respectively) occurred. It indicates a link between the increase in the sympathetic level of regulation and the presence of signs of psycho-emotional disorders. And also the growth of AMO in the 1st group (47,9±8,4%) shows the strength of sympathetic mobilising influence and evidences an increased medullary vasomotor centre activation and growth of sympathetic regulation in PsA patients with depression. In general, the severity of changes in HRV in PsA patients can be due to a high content of pro-inflammatory cytokines, which induce the synthesis of free acid radicals and worsen ANS maintenance of the organisms' activity. Conclusions: Emotional disorders of the anxiety-depressive spectrum contribute to the regulatory mechanisms tension increase and adaptive capabilities decrease in PsA patients, and also to the arousal of central heart rhythm regulation mechanisms combined disorders.