Pupillary autonomic dysfunction in patients with ANCA-associated vasculitis.

Area of Science:

• Neurology
• Immunology
• Ophthalmology

Background:

• Autonomic dysfunction is a known complication in autoimmune diseases.
• ANCA-vasculitis (AAV) can affect various organ systems, including the nervous system.
• Assessing autonomic function in AAV is crucial for understanding disease impact.

Purpose of the Study:

• To evaluate autonomic function in patients with AAV using infrared dynamic pupillometry.
• To correlate pupillary autonomic function with autonomic symptoms, clinical parameters, and cardiovascular reflex tests.
• To investigate the relationship between pupillary dysfunction and disease characteristics in AAV.

Main Methods:

• Infrared dynamic pupillometry was performed on 23 AAV patients and 18 controls at rest and after cold pressor test.
• Parasympathetic (amplitude, relative amplitude, constriction velocity) and sympathetic (late dilatation velocity) pupillary responses were measured.
• Results were correlated with COMPASS31 scores, heart rate variability, and blood pressure response to pain.

Main Results:

• AAV patients demonstrated significantly smaller pupil amplitude and slower constriction velocity compared to controls, both at baseline and after sympathetic stimulation.
• Relative pupil amplitude was reduced in AAV patients post-stimulation.
• No significant difference was found in sympathetic pupillary response between groups; parasympathetic response correlated with cardiac response and age.

Conclusions:

• Patients with AAV exhibit parasympathetic pupillary autonomic dysfunction.
• This pupillary dysfunction in AAV is associated with chronic disease damage rather than active inflammation or reported symptoms.
• Dynamic pupillometry is a valuable tool for assessing autonomic nervous system involvement in AAV.