Document Detail

Evidence of a selective nociceptive impairment in systemic sclerosis.
MedLine Citation:
PMID:  19796555     Owner:  NLM     Status:  MEDLINE    
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<0.01), a lower increase of diastolic BP during tilt test (p<0.01). They had suboptimal hypertensive and bradycardic response to the cold face test (Systolic BP: p<0.05; Diastolic BP: p<0.01; HR: p=0.08). The Valsalva manoeuver, deep breathing, isometric handgrip, BRSI and PSA of HRV results were within normal limits in the majority of SSc patients. CONCLUSION: In this group of SSc patients cardiovascular reflexes were normal, whereas the cold face test which acts through cutaneous nociceptive sensory fibres was abnormal in almost all patients. These results suggest that insufficiency of epidermal small fibres (C-fibres) is involved in SSc.
G Bajocchi; R Terlizzi; S Zanigni; G Barletta; D Grimaldi; G Pierangeli; P Cortelli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical and experimental rheumatology     Volume:  27     ISSN:  0392-856X     ISO Abbreviation:  Clin. Exp. Rheumatol.     Publication Date:    2009 May-Jun
Date Detail:
Created Date:  2009-10-02     Completed Date:  2010-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8308521     Medline TA:  Clin Exp Rheumatol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  9-14     Citation Subset:  IM    
Rheumatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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MeSH Terms
Autonomic Nervous System Diseases / complications,  physiopathology*
Blood Pressure
Cardiovascular System / innervation*,  physiopathology
Cold Temperature / diagnostic use
Face / physiology
Heart Rate
Middle Aged
Pain Measurement
Parasympathetic Nervous System / physiopathology
Raynaud Disease
Reflex, Abnormal
Scleroderma, Systemic / complications,  diagnosis,  physiopathology*
Sympathetic Nervous System / physiopathology
Valsalva Maneuver

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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