DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20194663

A prospective study on the prevalence of neurally mediated hypotension in systemic lupus erythematosus

Rajkumar Kannan, Jayakalyani Vijayananth, Sridhar Venu, Muthusubramanian Chandrasekar

Abstract


Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which affects skin and organ systems. Cardiovascular manifestations are one of the important cause for mortality and morbidity in SLE. Neurally mediated hypotension (NMH) caused by autonomic neuropathy is found to be associated with fibromyalgia responsible for chronic fatigue syndrome in SLE. Our study aims to find the prevalence of NMH in SLE.

Methods: This is a prospective study conducted in the Department of Dermatology, Chengalpattu Medical College from May 2017 to December 2018. All SLE patients who attended the Dermatology OPD were included in the study. The diagnosis of SLE was made based on the ARA criteria. After obtaining informed consent, baseline blood pressure of all patients included in the study were recorded. In patients with low blood pressure other causes of hypotension were ruled out. Patients with no discernible cause of hypotension were subjected to the two stage tilt table test. A drop in systolic BP of >20 mm of Hg or diastolic BP of >10 mm of Hg is considered to be positive.

Results: A total of 20 patients were included in the study, of which 19 were female and one male. The mean age was 31.7 years. 70% of the SLE patients included in our study were found to have NMH.

Conclusions: Neurally Mediated Hypotension was found to be highly prevalent in SLE.


Keywords


Hypotension in SLE, Autonomic neuropathy, Fibromyalgia in SLE, Postural orthostatic tachycardia syndrome

Full Text:

PDF

References


Tsokos GC. Systemic Lupus Erythematosus N Engl J Med. 2011;365:2110-21.

Mandell BF. Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum. 1987;17(2):126-41.

Badui E, Garcia-Rubi D, Robles E, Jimenez J, Juan L, Deleze M, et al. Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients. Angiology. 1985;36(7):431-41.

Tang S, Calkins H, Petri M. Neurally mediated hypotension in systemic lupus erythematosus patients with fibromyalgia. Rheumatology (Oxford). 2004;43(5):609-14.

Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21:69-72.

Hilz MJ, Ehmann EC, Pauli E, Baltadzhieva R, Koehn J, Moeller S, et al. Combined counter-maneuvers accelerate recovery from orthostatic hypotension in familial dysautonomia. 2012;126:162-70.

Klein CM, Vernino S, Lennon VA, Sandroni P, Fealey RD, Benrud-Larson L, et al. The spectrum of autoimmune autonomic neuropathies. Ann Neurol. 2003;53:752-8.

Singh NK, Jaiswal AK, Misra S and Srivastava PK. Assessment of autonomic dysfunction in Guillain-Barre syndrome and its prognostic implications. Acta Neurol Scand. 1987;75:101-5.