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Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability.

P H Dessein1, B I Joffe, R M Metz

  • 1Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.

The American Journal of Medicine
|August 1, 1992
PubMed
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Autonomic dysfunction is extremely common in systemic sclerosis (SSc), affecting all patients studied. This dysfunction involves parasympathetic impairment and significant sympathetic overactivity, especially in early disease stages.

Area of Science:

  • Cardiovascular Physiology
  • Neurology
  • Rheumatology

Background:

  • Systemic sclerosis (SSc) is a complex autoimmune disease.
  • Autonomic dysfunction (AD) is a potential complication of SSc.
  • Understanding AD in SSc is crucial for patient management.

Purpose of the Study:

  • To determine the prevalence and characteristics of autonomic dysfunction (AD) in patients with systemic sclerosis (SSc).
  • To investigate the relationship between AD and disease parameters in SSc.

Main Methods:

  • Evaluated 34 SSc patients using noninvasive cardiovascular autonomic function tests.
  • Measured sequential plasma catecholamine levels at rest and during physiological stress.
  • Assessed esophageal motility and catecholamines before and after clonidine treatment in a subset of patients.

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Main Results:

  • Autonomic dysfunction was identified in all 34 SSc patients.
  • Significant impairments in heart rate and blood pressure regulation were observed compared to controls.
  • Marked elevations in resting plasma adrenaline and inappropriate catecholamine fluctuations during stress were noted.
  • Headaches correlated with sympathetic overactivity, and adrenaline levels inversely correlated with disease duration.

Conclusions:

  • Autonomic dysfunction is nearly universal in systemic sclerosis.
  • The AD in SSc is characterized by parasympathetic deficits and pronounced sympathetic overactivity.
  • Further research is warranted to explore the role of AD in SSc pathogenesis.