ASSOCIATION OF PUPILLARY PARASYMPATHETIC HYPERREFLEXIA AND SYSTEMIC INFLAMMATION IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

In chronic inflammatory diseases, cytokines stimulate the hypothalamus -pituitary-adrenal axis and the hypothalamus-autonomic nervous system (HANS) axis. The present study was performed to find autonomic nervous function parameters in patients with systemic lupus erythematosus (SL E) which are suitable to demonstrate the activation of the HANS axis d uring systemic inflammation. Thirty-four patients with SLE (age 35.3 /- 1.9 yr) were investigated by seven standardized autonomic nervous f unction tests. The SLEDAI and laboratory parameters of systemic inflam mation were assessed by standard techniques. Pupillary latency time hy perreflexia was found in 29.4%, whereas maximal pupillary area was hyp erresponsive in only 2.9%. A total of 12% had overall cardiovascular a utonomic nervous hyperreflexia. Patients with latency time hyperreflex ia had more severe systemic inflammation [erythrocyte sedimentation ra te (ESR): P < 0.001; C-reactive protein (CRP): P = 0.0094; fibrinogen: P < 0.001; albumin: P = 0.003; antinuclear antibodies: P = 0.020]. Th e longitudinal study of 13 patients during 4 yr demonstrated a paralle l increase and decrease in latency time percentile and ESR. SLE patien ts with increased systemic inflammation had an activated HANS axis whi ch can be measured by a parasympathetic pupillary reflex test.