Altered function of the hypothalamic stress axes in patients with moderately active systemic lupus erythematosus. I. The hypothalamus-autonomic nervous system axis

Objective. To determine the human corticotropin releasing hormone (hCRH) in duced stress response of the hypothalamus-autonomic nervous system axis (HA NS) in patients with moderately active systemic lupus erythematosus (SLE). Methods. Cardiovascular and pupillary function variables were measured by s tandardized computer procedures before and during an hCRH test (6 time poin ts). The results of 12 patients with SLE were compared to 24 healthy subjec ts with (HS+P, n = 12) and without (HS, n = 12) prior administration of pre dnisolone 3 days before the test. Results. At baseline, diastolic blood pressure was significantly higher in SLE than in HS or HS+P (p < 0.001). During the hCRH test, patients with SLE had increased heart rates and systolic and diastolic blood pressure respon ses compared to HS+P and HS (p < 0.001 for all comparisons). Moreover, hear t rate variation was decreased at rest, during the lying-to-standing proced ure, and during the 2 applied respiratory tests (p < 0.01 vs HS). Compared to HS+P and HS, latency time of the pupillary light reflex was prolonged an d maximal pupillary area was increased, revealing sympathetic hyperreactivi ty. Conclusion. This study found an altered autonomic nervous system response a t baseline, which was more pronounced during the hCRH stress test in patien ts with moderately active SLE compared to healthy subjects. Baseline and st ress responses are characterized by a sympathetic overstimulation. Such a h ypersympathetic reaction may lead to increased risk of cardiovascular disea ses in patients with moderately active SLE, which needs to be investigated in longitudinal studies.