THE AUTONOMIC NERVOUS-SYSTEM AND THE IMMUNE-SYSTEM IN JUVENILE RHEUMATOID-ARTHRITIS

This study demonstrates that juvenile rheumatoid arthritis is associat ed with a dysregulation of the autonomic nervous system as well as wit h disturbances in the capacity of the immune system to respond to medi ators of the autonomic nervous system. In patients with active disease heart rate at rest is higher than in healthy controls. In addition, 3 -hydroxy-4-phenoxyphenylglycol levels in urine are higher in all patie nts than in the control group. Cardiovascular responses to an orthosta tic stress test (tilt up) are reduced in patients with active and nona ctive disease. Plasma norepinephrine responses to tilt up are reduced in subjects with active juvenile rheumatoid arthritis. In summary, our data show that patients with juvenile rheumatoid arthritis have an al tered function of the autonomic nervous system associated with increas ed central noradrenergic outflow, presumably leading to increased vaso constriction, resulting in a decreased response to an orthostatic stre ssor. The altered function of the autonomic nervous system is associat ed with changes in the response of leukocytes to mediators of the auto nomic nervous system via beta(2)-adrenergic receptors. Leukocytes of p atients with active juvenile rheumatoid arthritis have a lower cAMP re sponse to a beta 2-adrenergic agonist, presumably due to increased cAM P-phosphodiesterase activity in these cells. (C) 1996 Academic Press.