Evidence of reduced parasympathetic autonomic regulation in inflammatory joint disease: A meta-analyses study
Section snippets
Background
Cardiac autonomic dysfunction (AD) is linked to arrhythmias, all-cause mortality and death following myocardial infarction [1], [2]. There is a complex interplay between the immune and parasympathetic autonomic systems, with evidence of mutual regulation [3]. Parasympathetic AD is also linked to physical inactivity and is more prevalent in patients who suffer from chronic pain [4].
Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are inflammatory joint disorders (IJD) with an excess risk of
Methods
These meta-analyses were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement).
Theory and calculations
For the comparison of the disease groups with the healthy controls, we conducted random-effects meta-analyses using standardized mean differences. The analyses were run separately for patients with RA and SpA. Within each diagnostic category we ran separate meta-analyses for each of the variables RMSSD, HF, E-S, E-B and E-V. Sensitivity analyses were performed. Forest plots were examined for heterogeneity and when significant heterogeneity was displayed outliers were removed in descending order
Results
The final literature search was performed in August 2016. Supplementary Table 3 presents the complete search strategy. Supplementary Figure 1 presents a summary of the findings of literature search, screening and selection process. The database search identified 1015 records. In addition 120 records were found through searching grey literature (conference abstracts and internet searches) and bibliographies. After duplicates had been removed, 847 records remained, and these titles and abstracts
Discussion
This study reports significantly lower markers of cardiac parasympathetic modulation, measured as both RMSSD and HF, in patients with RA compared to healthy controls. RMSSD and HF values for SpA patients were comparable between patients and controls. For the Ewing battery the heart-rate variation was also significantly lower for patients vs. controls, except for the heart-rate variation under the Valsalva test in patients with RA which although numerically lower in RA patients did not reach
Conclusion
Patients with IJD have lower cardiac parasympathetic modulation compared to healthy controls. There is a cross-sectional inverse relationship between level of inflammation and parasympathetic AD.
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Disclosures: The authors S.A.P., E.E.S., G.S. and H.D. declare no conflict of interest. D.S.O. is currently employed by Polar Electro, Finland.
Funding statement: This work was sponsored by the Research Fund at Diakonhjemmet Hospital and by Extra-Stiftelsen, Norway. The sponsors have not been involved in the data-analyses, writing or submission of this paper.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.