Yaşar KESKİN, Kevser GÜMÜŞSU, Teoman AYDIN, Sevde ÖZER POŞUL, Esra BAŞAR GÜRSOY

Ankilozan Spondilit'te Otonomik Disfonksiyon Hastalık Sürecinin Bir İşareti midir? Bir Elektrofizyolojik Çalışma

Amaç: Bu çalışmada, ankilozan spondilitli (AS) hastalarda klinik ve elektrofizyolojik testler kullanarak otonom sinir sistemi (OSS) fonksiyonlarını değerlendirmeyi, hastalık özellikleriyle ilişkiyi araştırmayı ve verileri sağlıklı bireylerle karşılaştırmayı amaçladık. Yöntem: Bu kesitsel çalışmaya kırk AS hastası ve otuz sağlıklı kontrol grubu dahil edildi. İstirahatte kalp atışı, ayakta durmaya sistolik kan basıncı gibi klinik ölçümler alındı. OSS'nin elektrofizyolojik değerlendirmeleri sempatik cilt yanıtı ve R-R aralık varyasyon ölçümleri ile yapıldı. Hastalık aktivitesini tahmin etmek için Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) kullanıldı. AS'li hastalar da iki gruba ayrıldı; BASDAI≥4 ve BASDAI <4. Gruplar arasındaki fark ve OSS değişkenleri ile klinik özellikler arasında korelasyon belirlendi. Bulgular: AS hastalarının yaş ortalaması 35,2 ± 10,4, sağlıklı kontroller 34,4 ± 11,2 idi. Hastalar ortostatik değişimde solgunluk hissi, anormal terleme, bozulmuş bağırsak fonksiyonlarını kontrol grubundan daha fazla olduğunu ifade etmişlerdir. Hastaların istirahatte kalp atış hızı değerleri parasempatik disfonksiyonu gösteren kontrol bireylerinden daha yüksekti (p = 0,001). Bir sempatik fonksiyon testi olan ayakta durma sistolik kan basıncı yanıtı; her iki grupta da benzerdi. Parasempatik fonksiyon testi istirahatte R–R interval variation (RRIV) ve derin nefes alma sırasında RRIV her iki grupta benzerdi. Hasta ve kontrol grubu veya düşük ve yüksek hastalık aktivitesi olan hastalar arasında sempatik cilt yanıtı (SCY) latans ve amplitüdlerinde anlamlı bir fark bulunmadı (p> 0,05). SCY latansları ile CRP seviyeleri ile hastalık süreleri arasında bir ilişki vardı. Sonuç: OSS disfonksiyonu semptomları AS hastalarında kontrollerden daha sık gözlendi, ancak RRIV ve SCY ile değerlendirilen otonomik fonksiyonlarda anlamlı bir fark bulunmadı.

Anahtar Kelimeler:

Ankilozan Spondilit, Spondiloartrit, Otonom Sinir sistemi, R-R aralığı değişimi, Sempatik Deri Yanıtı

Is Autonomic Dysfunction a Sign of Disease Process in Ankylosing Spondylitis? An Electrophysiological Study

Objective: In this study, we aimed to evaluate autonomic nervous system (ANS) functions by using clinical and electrophysiological tests in patients with ankylosing spondylitis (AS), to investigate the relationship with the disease characteristics and to compare the data with healthy individuals.Methods: Forty AS patients and 30 healthy controls were included in this cross-sectional study. Clinical measurements including heart rate at rest, systolic blood pressure response to standing were obtained. The electrophysiological assessments of ANS were performed by sympathetic skin response and R–R interval variation measurements. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to estimate the disease activity. Patients with AS were also subdivided into two groups; BASDAI≥4 and BASDAI<4. The difference between the groups and correlations between ANS variables and clinical entities were determined. Results: Mean age of AS patients were 35,2±10,4 years and healthy controls were 34,4±11,2 years. Patients expressed feeling of faintness in orthostatic change, abnormal sweating, disturbed bowel function more than control subjects. The patient’s heart rate values at rest were higher than control subjects which indicate parasympathetic dysfunction (p=0,001). As a sympathetic function test, systolic blood pressure response to standing was similar in both groups. The parasympathetic function test R–R interval variation (RRIV) at rest and RRIV during deep breathing were similar in both groups. No significant difference was found on sympathetic skin response (SSR) latencies and amplitudes between patients and control groups or patients with low and high disease activity (p>0,05). A correlation was found between SSR latencies and CRP levels and disease durations. Conclusions: The symptoms of ANS dysfunction were observed more frequently in AS patients than controls but no significant difference of autonomic functions as assessed by RRIV and SSR was found.

Keywords:

Ankylosing Spondylitis, Spondyloarthritis, Autonomic Nervous system, R-R interval variation, Sympathetic Skin Response,

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