AUTONOMIC DYSFUNCTION IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective. To assess the prevalence and severity of autonomic dysfunct ion (AD) in patients with systemic lupus erythematosus (SLE). Methods. Fifty-nine consecutive patients with SLE and 97 healthy controls were assessed for AD using 4 noninvasive tests: heart rate responses to th e Valsalva maneuver (Val), maximum-minimum heart rate (MM) response to deep breathing, heart response to standing up (30:15 ratio), and chan ges in blood pressure to sustained handgrip (Hand). AD was categorized as incipient, definite, severe, or atypical according to criteria pro posed by Ewing, Disease characteristics, comorbid conditions, disease activity index [Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI)], cardiac complaints, and drug history were also do cumented. Laboratory analysis included rheumatoid factor, antinuclear antibodies, anti-dsDNA antibodies, and anticardiolipin antibodies (aCL ).Results. Forty-eight percent of the patients with SLE had one or mor e abnormal tests compared with 33% of the controls (p = 0.05); differe nces were greater when the severity of the neuropathy was considered: 12 (21%) patients with SLE had definite or severe AD using Ewing's cri teria, compared with only 2 (2%) controls (p < 0.001). No statistical associations were observed between AD and age, disease duration, hyper tension, Mex-SLEDAI, anti-dsDNA, aCL antibodies, or other drugs. Concl usion. The prevalence of AD in SLE using noninvasive tests is high. On e-fifth of our patients had definite or severe AD. No significant asso ciations were observed between AD and clinical or serological variable s of disease activity. Prospective studies are needed to determine the potential effect of AD in the morbidity of patients with SLE.