title: Disease-modifying antirheumatic drugs improve cardiovascular autonomic neuropathy in psoriatic arthritis.
abstract: BACKGROUND
  Cardiovascular autonomic neuropathy (CAN) is a significant risk predictor for sudden cardiac death in autoimmune rheumatic diseases. As yet, there is no therapeutic treatment of CAN in psoriatic arthritis (PsA). Even now, the impact of the most commonly employed disease-modifying antirheumatic drug (DMARD) therapy on CAN in PsA is not known. Hence, we investigated the impact of DMARDs on CAN in PsA.
  
  
  METHODS
  In this prospective, cross-sectional study, 20 patients of PsA and 20 age- and sex-matched healthy controls were recruited. CAN was diagnosed by applying the five cardiovascular reflex tests according to Ewing. Parasympathetic dysfunction was established by performing three tests: heart-rate response to deep breathing, standing, and Valsalva tests. Sympathetic dysfunction was examined by applying two tests: blood pressure response to standing, and handgrip tests. Disease severity was assessed by the 28-joint-count disease activity score (DAS-28) and the disease activity score in psoriatic arthritis (DAPSA).
  
  
  RESULTS
  Cardiovascular reflex tests were impaired significantly among the PsA patients compared with well-matched healthy subjects (p < 0.05). Parasympathetic dysfunction was more prominent than sympathetic dysfunction. After 12 weeks treatment, parasympathetic dysfunction (heart rate response to deep breath and standing) significantly (p < 0.05) improved in patients with PsA, while there was no significant improvement in sympathetic function.
  
  
  CONCLUSIONS
  These study results suggests parasympathetic autonomic dysfunction is more prominent than sympathetic dysfunction in PsA. Synthetic DMARDs improved parasympathetic dysfunction in PsA.
authors.affiliation: Cardio Rheuma and Healing Touch City Clinic, Chandigarh and Rheumatologist, Fortis Multi-Speciality Hospital, Mohali, Punjab, India.
authors.forename: Ashit
authors.initials: A
authors.lastname: Syngle
authors.affiliation: Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India.
authors.forename: Inderjeet
authors.initials: I
authors.lastname: Verma
authors.affiliation: Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, Punjab, India.
authors.forename: Pawan
authors.initials: P
authors.lastname: Krishan
authors.affiliation: Healing Touch City Clinic, Chandigarh, India.
authors.forename: Vijaita
authors.initials: V
authors.lastname: Syngle
keywords: cardiovascular autonomic neuropathy; disease-modifying antirheumatic drugs; inflammation; psoriatic arthritis