Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures

Autonomic nervous dysfunction has been previously reported in SLE, RA and systemic sclerosis, but the pathogenesis of such a complication is poorly understood. In the present study, four standard cardiovascular autonomic function tests were performed in 34 female patients with connective tissue diseases and in 25 healthy control subjects, and results expressed as cardiovascular (CV) test scores. Moreover, in each subject the presence of circulating complement-fixing autoantibodies directed against sympathetic and parasympathetic nervous structures, represented by superior cervical ganglia and vagus nerve, respectively, was simultaneously assessed by an indirect immunofluorescent complement-fixation technique, using rabbit tissue as substrate. None of the patients reported autonomic symptoms. However, an abnormal CV test score (> or = 5) was detected in 15% of the patients and in none of the healthy control subjects, approaching statistical significance (P = 0.07). No correlation was found between CV test results and disease duration, type of therapy or presence of conventional autoantibodies. One or two autoantibodies to autonomic nervous structures were detected in six patients (18%) and not in the control subjects (P < 0.05). Values of deep breathing test were significantly lower in autoantibody-positive patients compared with those amongst the control subjects (P < 0.05), and an abnormal CV test score was significantly associated with the presence of autoantibodies to autonomic nervous structures (P < 0.05). In conclusion, we confirm that autonomic nervous function can be impaired in patients with connective tissue diseases, and suggest that autoantibodies directed against autonomic nervous system structures may play a role in the pathogenesis of the autonomic dysfunction.

[Crohn's disease in prolonged remission: should one augment protein-calorie intake as compared to healthy subjects?]

The aim of our two year prospective study was to evaluate whether adult Crohn's disease patients in prolonged remission (CDAI < 150), in order to maintain their body weight as close as possible to the ideal one, need a protein-calorie intake higher than the predicted one and that of healthy controls. Twenty-four out of 49 Crohn's disease patients in clinical remission completed the two year prospective study, during which they were free to eat "ad libitum", in quantity and in quality. Twenty-three of the 24 patients (96%) maintained their body weight > 95% of the ideal one. As compared to predicted intakes, mean calories were -12.23% (= 272 +/- 91 Kcal/day) lower (P < 0.01), and proteins +40.6% (20.16 +/- 13.6 g/day; = 0.32 g/kg b.w./day) higher (p < 0.001). Protein-calorie intake and glycolipid ratio were comparable to those of healthy controls (p = n.s.). In the group of patients who had a relapse during the follow-up, 9 out of 25 were found to be underweight at the onset of the survey. Their protein-calorie intake was equivalent to that of subjects who completed the study. We conclude that adult Crohn's disease patients in prolonged remission maintain their ideal body weight by a protein-calorie intake comparable to that of healthy population and do not need a tailored regimen.

[Clinical characteristics of 153 patients with Crohn's disease. Presentation of a Turin case series]

This clinical and epidemiological retrospective study of 153 Italian Crohn's disease patients, surveyed between 1965 and 1988 took into account the following features: male to female ratio; region of origin; familiarity; age at onset; anatomical site of lesions; symptoms at onset; diagnostic delay; local and general complications; relapses; admissions; surgery and mortality rates. The clinical patterns of 67 patients surveyed between 1965 and 1977 (group A) were compared with those of 86 patients observed from 1978 to 1988 (group B). Overall results agreed with those of the literature, except for a male prevalence and a longer diagnostic delay. As compared to group A, group B showed: a) a higher number of females; b) a statistically significant increase (p less than 0.001) of patients from Southern Italy, thus supporting the hypothesis of a role of environmental factors in the onset of the disease; c) a reduced surgery rate, in agreement with the general trend of a more cautious surgical approach in Crohn's disease.