title: Cardiovascular autonomic function assessed by autonomic function tests and serum autonomic neuropeptides in Egyptian children and adolescents with rheumatic diseases.
abstract: OBJECTIVE
  Cardiovascular autonomic neuropathy (CAN) in patients with rheumatic diseases may result in sudden death, possibly from arrhythmia and myocardial infarction due to its frequent association with microvascular disease. Autonomic dysfunction may contribute to initiation and perpetuation of rheumatic diseases. Thus, we aimed to assess cardiovascular autonomic function in lupus and juvenile idiopathic arthritis (JIA) patients.
  
  
  METHODS
  Assessment of cardiovascular autonomic function was done in 20 lupus and 20 JIA patients, aged 8-16 years, by five non-invasive autonomic function tests (AFTs) and serum levels of neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP), as indicators of sympathetic and parasympathetic functions, respectively, in comparison with 40 matched healthy control subjects.
  
  
  RESULTS
  Clinical evidence of CAN was found in 65 and 40% of lupus and JIA patients, respectively, and in none of healthy controls. Lupus and JIA patients had significantly lower serum NPY and VIP than controls (P < 0.001). The five AFTs score had significant negative correlations to NPY and VIP (P < 0.001). Patients with CAN had significantly lower serum NPY and VIP than patients without (P < 0.001). Clinical evidence of CAN was found in 41.7 and 14.3% of asymptomatic lupus and JIA patients, respectively. There was significant positive association between CAN and important disease manifestations, including activity, in these patients.
  
  
  CONCLUSIONS
  CAN is common in lupus and JIA patients, even in absence of relevant symptoms. Thus, assessments of cardiac autonomic function, by AFTs and serum autonomic neuropeptides (NPY and VIP), and the therapeutic effects of NPY and VIP are recommended in these patients.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt.
authors.forename: Zeinab A
authors.initials: ZA
authors.lastname: El-Sayed
authors.forename: Gehan A
authors.initials: GA
authors.lastname: Mostafa
authors.forename: Gamal S
authors.initials: GS
authors.lastname: Aly
authors.forename: Ghada S
authors.initials: GS
authors.lastname: El-Shahed
authors.forename: Manal M Abd
authors.initials: MM
authors.lastname: El-Aziz
authors.forename: Safaa M
authors.initials: SM
authors.lastname: El-Emam
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000097:blood / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D002319:Cardiovascular System / Q000294:innervation*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D004534:Egypt; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000503:physiopathology; D008297:Male; D009478:Neuropeptide Y / Q000097:blood; D009479:Neuropeptides / Q000097:blood*; D011187:Posture; D012216:Rheumatic Diseases / Q000097:blood* / Q000503:physiopathology*; D014660:Vasoactive Intestinal Peptide / Q000097:blood
chemical_list: D009478:Neuropeptide Y; D009479:Neuropeptides; D014660:Vasoactive Intestinal Peptide