Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 11, November, p. 1587–1592

doi: 10.17219/acem/75618

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Analysis of peripheral nerve and autonomic nervous system function and the stage of microangiopathy in patients with secondary Raynaud’s phenomenon in the course of connective tissue diseases

Izabela Gosk-Bierska1,A, Maria Misterska-Skóra2,B, Marta Wasilewska1,B, Małgorzata Bilińska3,C, Jerzy Gosk4,D, Rajmund Adamiec1,E, Magdalena Koszewicz3,A,C

1 Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Poland

2 Department and Clinic of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland

3 Department and Clinic of Neurology, Wroclaw Medical University, Poland

4 Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, Poland

Abstract

Background. The pathogenesis of secondary Raynaud’s phenomenon (SRP) associated with connective tissue diseases (CTD) is not entirely understood. Nervous system dysfunction and microangiopathy are considered to be causes of this pathology.
Objectives. Peripheral and autonomic nervous system function, the stage of microangiopathy, and the relationships between these in patients with SRP were analyzed.
Material and Methods. In the study, 20 patients with CTD-related SRP and 30 healthy controls were subject to capillaroscopy, standard conduction velocity tests and conduction velocity distribution (CVD) tests in ulnar and peroneal nerves, heart rate variability (HRV), and sympathetic skin response (SSR) tests.
Results. There were no significant differences in the standard motor and sensory conduction velocity tests, or in CVD tests in the ulnar and peroneal nerves in SRP patients compared with the controls. The patients with SRP had a significantly lower SSR amplitude and longer latency in hands and feet. The patients with CTD-related SRP had a significantly lower mean HRV with higher low frequency (LF) values in the spectral analysis and expiration/inspiration ratio (E/I) during deep breathing. There was no correlation between the stage of microangiopathy and neurophysiological test results.
Conclusion. Correct standard conduction velocity and CVD testing in patients with SPR suggest that vasomotor disturbances may occur in CTD regardless of peripheral neuropathy. The lack of relationship between SSR and microangiopathy could confirm that these 2 processes occur independently in patients with CTD-related SRP. Autonomic nervous system impairment together with normal peripheral nerve function suggest the central origin of CTD-related SRP.

Key words

microangiopathy, connective tissue diseases, secondary Raynaud’s syndrome, peripheral nerves, autonomic nervous system

References (25)

  1. Raynaud M. On local asphyxia and symmetrical gangrene of the extremities 1862. New researches on the nature and treatment of local asphyxia of the extremities. In: Barlow T, trans. Selected monographs. London, UK: New Sydenham Society; 1874.
  2. Harper FE, Maricq HR, Turner RE, et al. A prospective study of Raynaud’s phenomenon and early CTD. A five-year report. Am J Med. 1982;72:883–888.
  3. Herrick AL. Pathogenesis of Raynaud’s phenomenon. Rheumatology. 2005;44:587–596.
  4. Pavlov-Dolijanovic S, Damjanov NS, Stojanovic RM, et al. Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: A follow-up study of 3,029 patients with primary Raynaud’s phenomenon. Rheumatol Int. 2012;32(10):3039–3045.
  5. Wu PC, Huang MN, Kuo YM, Hsieh SC, Yu CL. Clinical applicability of quantitative nailfold capillaroscopy in differential diagnosis of connective tissue diseases with Raynaud’s phenomenon. J Formos Med Assoc. 2013;112(8):482–488.
  6. Maricq HR, Le Roy EC, D’Angelo WA, et al. Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum. 1980;23:183–189.
  7. Andreadou E, Zouvelou V, Karandreas N, et al. Anti-myelin-associated glycoprotein polyneuropathy coexistent with CREST syndrome. J Postgrad Med. 2012;58:57–59.
  8. Gunatilake SS, Wimalaratna H. Guillain-Barré syndrome presenting with Raynaud’s syndrome. A case report. BMC Neurol. 2014;14:174.
  9. Jasmin R, Sockalingam S, Ramanaidu LP, Goh KJ. Clinical and electrophysiological characteristics of symmetric polyneuropathy in a cohort of systemic lupus erythematosus patients. Lupus. 2015; 24(3):248–255.
  10. Omdal R, Bekkelund SI, Meligren SI, et al. C-fibre function in systemic lupus erythematosus. Lupus. 1996;5:613–617.
  11. Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Systemic Lupus International Collaborating Clinics. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study. Arthritis Rheum. 2007;56:265–273.
  12. Sim MK, Kim DY, Yoon J, et al. Assessment of peripheral neuropathy in patients with rheumatoid arthritis who complain of neurologic symptoms. Ann Rehabil Med. 2014;38:249–255.
  13. Oh SJ. Clinical Electromyography: Nerve Conduction Studies. Lippincott, PA: Williams and Wilkins; 2003.
  14. Kleiger RE, Stein PK, Bigger JT. Heart rate variability: Measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10:88–101.
  15. Koszewicz M, Gosk-Bierska I, Bilińska M, et al. Autonomic dysfunction in primary Raynaud’s phenomenon. Int Angiol. 2009;28:127–131.
  16. Elie B, Guiheneuc P. Sympathetic skin response: Normal results in different experimental conditions. Electroencephalogr Clin Neurophysiol.
  17. Uncini A, Pullman SL, Lovelace RE, et al. The sympathetic skin response: Normal values, elucidation of afferent components and application limits. J Neurol Sci. 1988;87:299–306.
  18. Gerhard-Herman M, Gardin JM, Jaff M, et al. Guidelines for noninvasive vascular laboratory testing: A Report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr. 2006;19:955–972.
  19. Maricq HR. Widefield capillary microscopy. Technique and rating scale for abnormalities seen in scleroderma and related disorders. Arthritis Rheumatol. 1981;24:1159–1166.
  20. Koszewicz M, Gosk-Bierska I, Gosk J, et al. Peripheral nerve changes assessed by conduction velocity distribution in patients with primary Raynaud’s phenomenon and dysautonomia. Int Angiol. 2011;30:375–379.
  21. Manek NJ, Holmgren AR, Sandroni P, et al. Primary Raynaud's phenomenon and small-fibre neuropathy: Is there a connection? A pilot neurophysiologic study. Rheumatol Int. 2011;31:577–585.
  22. Mondelli M, Romano C, De Stefano R, et al. Nerve conduction velocity study of the upper limb in Raynaud’s phenomenon. Rheumatol Int. 2000;19:165–169.
  23. Charkoudian N. Skin blood flow in adult human thermoregulation: How it works, when it does not, and why. Mayo Clin Proc. 2003;78: 603–612.
  24. Kaheleh B, Matucci-Cerinic M. Raynaud’s phenomenon and scleroderma. Dysregulated neuroendothelial control of vascular tone. Arthritis Rheumatol. 1995;38:1–4.
  25. Edwards CM, Marshall JM, Pugh M. Lack of habituation of the pattern of cardiovascular response evoked by sound in subject with primary Raynaud’s disease. Clin Sci. 1998;95:249–260.
© Wroclaw Medical University