Evidence of a selective nociceptive impairment in systemic sclerosis G. Bajocchi1, R. Terlizzi2, S. Zanigni2, G. Barletta2, D. Grimaldi2, G. Pierangeli2, P. Cortelli2 Rheumatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; 2 Neurological Clinic, Department of Neurological Sciences, University of Bologna, Italy. Gianluigi Bajocchi, MD Rossana Terlizzi, MD Stefano Zanigni, MD Giorgio Barletta, MD Daniela Grimaldi, MD Giulia Pierangeli, Professor Pietro Cortelli, Professor Please address correspondence to: Bajocchi Gianluigi, MD, Rheumatology Unit, Arcispedale Santa Maria Nuova Reggio Emilia, Italy. E-mail:
[email protected] Received on July 10, 2008; accepted in revised form on November 21, 2009. Clin Exp Rheumatol 2009: 27 (Suppl. 54): S9-S14. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2009. 1
Key words: Systemic sclerosis, Raynaud’s phenomenon, cardiovascular autonomic dysfunction, heart rate variability, small fibres neuropathy. Abbreviations: ANS: autonomic nervous system; SSc: systemic sclerosis; dcSSc: diffuse cutaneous systemic sclerosis; lcSSc: limited cutaneous systemic sclerosis; RP: Raynaud’s phenomenon; BP: blood pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; HRV: heart rate variability; PSA: power spectral analysis.
Competing interests: none declared.
ABSTRACT Objective. To test for the autonomic neuropathy in systemic sclerosis (SSc) using cardiovascular reflex evaluation including the “cold face test”, which elicits forehead cold receptors (C-fibres). These tests examine the induced bradycardia-hypertensive response and the integrity of nociceptive afferent and parasympathetic-sympathetic efferent pathways. Methods. Twelve SSc patients were studied; including 5 with the limited cutaneous (lcSSc) involvement, and 7 with diffuse cutaneous involvement (dcSSc). All patients were matched with healthy controls. We performed cardiovascular autonomic tests (tilt-test, Valsalva manoeuver, deep breathing, sustained handgrip and cold face) with continuous monitoring of beat-to-beat blood pressure (BP) and heart rate (HR). Baroreceptor sensitivity index (BRSI) and power spectral analysis (PSA) of heart rate variability (HRV) were also evaluated. Results. SSc patients showed a statistically significant higher HR at rest (p
