An analysis of age-related loss of skeletal muscle mass and its significance on osteoarthritis in a Korean population

BACKGROUND/AIMS: This study was conducted in order to analyze the effects of sarcopenia on age-related osteoarthritis (OA) of the knee in a Korean population. METHODS: All the Korean subjects who visited the Yeungnam University Medical Center Health Promotion Center between 2008 and 2012 in order to undergo a routine medical examination were enrolled. A total of 5,723 young, healthy people (2,959 males, 2,764 females) enrolled as normal subjects and 23,473 subjects (13,006 males and 10,467 females) were included for evaluation of the effects of sarcopenia on OA. There were 266 subjects who followed-up bioelectrical impedance analysis at a 4-year interval. Of 327 subjects enrolled in this study, knees with anteroposterior X-rays were assessed according to the Kellgren-Lawrence (K/L) grade. RESULTS: Skeletal muscle mass index (SMI) and basal metabolic rate (BMR) showed a steady decrease with the advance of age (p < 0.01), but SMI showed strong positive correlation with BMR (r = 0.72, β = 30.96, p < 0.01). During the 4-year interval, BMR showed a significant decrease with aging (p < 0.01), consistently with the decrease of SMI. Knees with normal SMI were prone to be designated as K/L grade 0 or 1; however, subjects with sarcopenia showed a trend toward the higher K/L grade, classified as knee radiological osteoarthritis (ROA) (p < 0.01). CONCLUSIONS: The results of this study may indicate that sarcopenia as age-related loss of skeletal muscle mass is interactively correlated with the presence and severity of age-related OA.

An overlap syndrome of Churg-Strauss syndrome and rheumatoid arthritis / 영남의대학술지

Churg-Strauss syndrome (CSS) is a necrotizing vasculitis with extra-, peri-vascular eosinophilic infiltration. Chronic symmetric polyarthritis with the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody are the mainstay of rheumatoid arthritis (RA) diagnosis. Mononeuritis multiplex is a peripheral neuropathy involving more than 2 separate nerve areas. A 62-year-old male patient was referred for left foot drop and polyarthritis of both hands and feet for 4 months. During evaluation, mononeuritis multiplex was detected on nerve conduction study and electromyography tests: vasculitis with neutrophil, eosinophil, and lymphocyte infiltration on peroneal nerve biopsy. A positive response to methacholin and bronchodilator was observed on the pulmonary function test. Radiologic tests showed peri-articular soft tissue swelling and osteopenia on both hand and foot. Marked peripheral eosinophilia, high RF, and positive perinuclear anti-neutrophil cytoplasmic antibody were detected on blood tests. Here, we report on a patient with overlap syndrome of CSS and RA with review of the relevant literature, from which a few references to overlap syndrome of CSS and RA were available.

Polyglandular Autoimmune Syndrome Type 2 Complicated by Multiple Organ Failure, Empty Sella Syndrome and Aplastic Anemia

Polyglandular autoimmune syndrome (PAS) is a group of syndromes comprised of glandular and extra-glandular disorders characterized by autoimmunity. A 57-year-old woman presented with acute progressive dyspnea and generalized weakness for several months. The patient was assessed to have acute congestive heart failure with cardiomyopathy, chronic renal failure with hyporeninemic hypoaldosteronism, and pancytopenia in addition to primary hypothyroidism and adrenal insufficiency. With the diagnosis of PAS type 2 complicated by multiple organ failure (MOF), medium-dose prednisolone (30 mg/d) was introduced primarily to control the activity of autoimmunity, which triggered MOF over the adrenal insufficiency. Levothyroxine (25 microg/d) was followed for replacement of the thyroid hormone deficiency. However, the symptoms and signs fluctuated, depending on the dosage of prednisolone, and progressively worsened by empty sella syndrome and aplastic anemia. Here, we report on a case of PAS type 2 with MOF and atypical complications, and suggest that recognition, assessment, and control of PAS as a systemic autoimmune disease may be essential.

Immune thrombocytopenia associated with sarcoidosis / 영남의대학술지

Sarcoidosis is a systemic disease of unknown cause involving multiple organs and is characterized by noncaseating granuloma. Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased peripheral platelet destruction due to the presence of an antibody to the platelet and abnormal platelet production. There is no known pathogenesis that occurs concurrently with ITP and sarcoidosis. However, considering together of 2 known pathogenesis, abnormal immune response triggers either ITP or sarcoidosis. The disease that develops first stimulates secondary disease. After development of secondary disease, they stimulate each other. A few cases of ITP associated with sarcoidosis are well documented in English; however, the disease has rarely been reported in Korea. Here, we report on a case of ITP with sarcoidosis in a 29-year-old man. He suffered from easy bruising. The chest X-ray and the contrast-enhanced computed tomography scan showed bihilar lymphadenopathy and reticulonodular infiltrates. Bone marrow study and fluoroscopy-guided percutaneous needle biopsy were performed and the patient was diagnosed with sarcoidosis and ITP. He was put on 400 mg/kg of intravenous immunoglobulin for 5 days and administered oral steroids and further follow-up will be carried out. He has shown a good response without significant bleeding event. However, administration of more oral steroid and additional follow-up is required than for single disease, whether sarcoidosis or ITP.

Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis

The purpose of this study was to evaluate the effects of rheumatoid arthritis (RA) and antirheumatic drugs on atherosclerosis by comparing carotid intima-media thickness (CIMT) as an indicator for cardiovascular diseases (CVD). This study included 44 female RA patients who met the 2010 ACR/EULAR criteria and age-matched 22 healthy females. CIMT was measured on both carotid arteries using a B-mode ultrasound scan. The mean value of both sides was taken as the CIMT of the subject. The CIMT was evaluated according to the use of drugs, disease activity and CVD risk factors in RA patients as a case-control study. Higher CIMT was observed in RA patients as compared with healthy subjects (0.705 +/- 0.198 mm, 0.611 +/- 0.093 mm, respectively, P < 0.05). With adjustment for the CVD risk factors, disease activity and the use of anti-rheumatic drugs, methotrexate (MTX) only showed a favorable effect on CIMT in RA. A significantly lower CIMT was observed in RA with MTX as compared with RA without MTX (0.644 +/- 0.136 mm, 0.767 +/- 0.233 mm, respectively, P < 0.05). The effects were correlated with MTX dosage (beta = -0.029, P < 0.01). The use of MTX should be considered in high priority not only to control arthritis but also to reduce the RA-related CVD risk to mortality.

Age-related NADPH Oxidase (arNOX) Activity Correlated with Cartilage Degradation and Bony Changes in Age-related Osteoarthritis

The purpose of this study was to investigate the age-related NADPH oxidase (arNOX) activity in patients with age-related knee osteoarthritis (OA). Serum and cartilage arNOX activities were determined using an oxidized ferricytochrome C reduction assay. Full-thickness knee joint cartilages obtained through total knee replacement surgery were graded according to the Outerbridge (OB) classification. Radiographic severity of OA was determined on Knee X-rays according to the Kellgren-Lawrence (K/L) grading system. Cartilage beta-galactosidase, HIF-1alpha, and GLUT-1 expression levels were evaluated as markers for tissue senescence, hypoxia, and glycolysis. Higher arNOX activities occurred with higher levels of cartilage beta-galactosidase, HIF-1alpha, and GLUT-1 (P = 0.002). arNOX activity in cartilages with surface defects (OB grade II, III) was higher than in those without the defects (OB grade 0, I) (P = 0.012). Cartilage arNOX activity showed a positive correlation with serum arNOX activity (r = -0.577, P = 0.023). Serum arNOX activity was significantly higher in the OA subgroup with bilateral ROA than in the OA with no or unilateral ROA (2.449 +/- 0.81, 2.022 +/- 0.251 nM/mL, respectively, P = 0.019). The results of this study demonstrate that OA itself is not a cause to increase arNOX activities, however, arNOX hyperactivity is related to a high degree of cartilage degradation, and a high grade and extent of ROA in age-related OA.

A Case of Pseudolymphomatous IgG4-Related Disease Involving the Maxilla / 영남의대학술지

Immunoglobulin G4 (IgG4)-related disease is an inflammatory condition characterized by IgG4 positive plasma cell infiltration. It can affect any organ in the body and mainly involves the pancreas, liver, biliary tracts, orbits, salivary glands and lymph nodes. It can manifest as an inflammatory pseudotumor. Pseudolymphoma as an inflammatory pseudotumor is a group of benign tumors that exhibit histological and clinical features suggestive of malignant lymphoma. Studies on IgG4-related disease are rarely reported, and no case of the disease that involved the maxillary bone and adjacent soft tissue, except for the skin, has been reported. Therefore, we report herein a case of pseudolymphomatous IgG4-related disease that involved the maxilla, with a literature review.

A Comparison of Compression Rates on the Quality of Cardiopulmonary Resuscitation

PURPOSE: In cardiopulmonary resuscitation (CPR) there are different opinions on the compression rate that should be applied. The aim of this study was to compare the total number of adequate compressions delivered during a five-minute period among four groups of lay persons (> or =139 min-1, 129-138, 114-128, and 100 times/minute and a depth of >5 cm for five minutes. A total of 86 participants were then divided into four groups based on their mean compression rate. Age, sex, and body mass index were analyzed as factors affecting the compression rates. RESULTS: The group delivering a compression rate above 139 compressions min-1 performed better than those delivering below 114 compressions min-1 (p=0.03). There was no significant difference in the mean compression depth (p=0.13), percentage of incomplete chest recoil (p=0.277), or the percentage of incorrect hand positioning (p=0.091). All participants (except five) performed chest compressions at a rate above 100 compressions min-1. CONCLUSION: Our results suggest that a chest compression rate above 139 compressions min-1 does not deteriorate the quality of compressions compared to a lower chest compression rate (below 114 min-1) during a five-minute period. Most untrained lay people performed chest compressions well, within a range of 100~150 min-1.

A Case of Type I Cryoglobulinemia Associated with Smoldering Myeloma and Acutely Reactivated Chronic Hepatitis B

A 58-year-old male patient with chronic hepatitis B infection and hypertension was referred for the evaluation of a skin rash. The skin biopsy showed multiple hyaline thrombi in small blood vessels, red blood cell extravasation, and epidermal atrophy. The CBC, chemistry, UA, and radiological studies were unremarkable except for elevated AST/ALT on liver function tests. The hepatitis B virus markers were compatible with the diagnosis of acute replicative phase chronic hepatitis B; HBeAg 86,646 cpm (count per minute), anti-HBeAb (-), HBV PCR (Quantitative) >1.10x108 IU/mL, and >640,200,000 copies/mL. Rouleaux formation was seen on the peripheral blood smears. Serum PEP/IEP demonstrated an M-spike (27.53%) in the gamma region and abnormal bowed arcs in IgG, kappa light chain with Cryoglobulin (+), ANCA (+), FANA (-), and rheumatoid factor (-) on the serological test. The percent of plasma cells on the bone marrow biopsy was approximately 15%. Type I cryoglobulinemia is a rare disease that can be associated with hematologic disorders, but smoldering myeloma or/and hepatitis B has not been reported in association with Type I cryoglobulinemia. Here, we report a case of Type I cryoglobulinemia that showed multiple skin ulcers due to vascular occlusion related to the monoclonal cryoglobulin with smoldering myeloma and acutely reactivated chronic hepatitis B.

A Case of Minimal Change Disease Treated Successfully with Mycophenolate Mofetil in a Patient with Systemic Lupus Erythematosus

The World Health Organization classifies lupus nephritis as class I to V or VI. However, a few cases of minimal change glomerulopathy have been reported in association with systemic lupus erythematosus (SLE). Mycophenolate mofetil has been shown to be effective for treatment of minimal change disease and lupus nephritis. A 24-year-old woman diagnosed with SLE five years prior to presentation complained of a mild generalized edema. The urinalysis showed microscopic hematuria and proteinuria. The assessed amount of total proteinuria was 1,618 mg/24 hours. A renal biopsy demonstrated diffuse fusion of the foot processes of podocytes on electron microscopy. Mycophenolate mofetil was started in addition to the maintenance medications of prednisolone 10 mg/day and hydroxychloroquine 400 mg/day. After six months of treatment, the microscopic hematuria and proteinuria resolved, and the total urine protein decreased to 100 mg/24 hours.

A Case of Systemic Lupus Erythematosus Misdiagnosed as Adult-onset Still's Disease / 영남의대학술지

Adult-onset Still's disease (AOSD) is an inflammatory disorder that's characterized by daily, spiking high fever, arthritis and an evanescent, salmon-pink rash. AOSD is diagnosed purely on the basis of the typical clinical features of the illness. The symptoms commonly include swelling of the lymph nodes, enlargement of the spleen and liver, and a sore throat. AOSD is difficult to differentiate from systemic lupus erythematosus (SLE) due to the similar clinical manifestations. We report here on a case of a 16-year-old female patient with autism and epilepsy and who complained of daily spiking fever for 20 days. The patient had maculopapular skin rashes on the face and whole body and lymphadenopathy. The liver function tests were elevated mildly. The initial rheumatoid factor (RF) and antinuclear antibody (ANA) tests were negative. We diagnosed her as having adult-onset Still's disease according to the criteria of Yamaguchi. We successfully treated her with oral prednisolone. But her antinuclear antibody test was changed to positive after discharge. So we finally diagnosed her as having SLE.

Non-specific Inflammatory Disease Showed Abnormal FDG Uptake in Lower Extremities / 핵의학분자영상

Including malignancy, various disease can show abnormal uptake in bone marrow.1,2) We report a case of non-specific inflammatory FDG uptake in bone marrow mimicking malignancy. A 35-year old woman with fever of unknown origin (FUO) underwent 18F-FDG PET/CT to find out fever focus and unknown malignancy. 18F-FDG was injected and imaged 1hr after injection with Discovery ST (GE, USA). 18F-FDG PET/CT whole body image showed abnormal uptake in lower extremities (Fig. 1). MRI and biopsy was also done in the sites of abnormal uptake. PET and MRI suspect malignancy (Fig. 2, 3), but biopsy result was non-specific inflammatory process (Fig. 4). The patient was improved her clinical condition after antibiotics therapy.

Three Cases of Fever Unknown Origin with Lymphoproliferative Features and a Unique Pattern of 18-FDG Uptake on the Fusion PET/CT / 영남의대학술지

Evaluation of a fever of unknown origin (FUO) is complex. Recently, PET scanning has been approved for screening in FUO evaluation. We treated three cases of FUO associated with increased FDG uptake in the bone marrow of the femur and tibia on the fusion PET/CT; all three had the same pattern of uptake. Bone marrow biopsies revealed mature lymphocyte and histiocyte infiltration and myxoid changes in one case, and cortical bone involvement in another case. The cases were all young females who had fever with neutropenia and relative lymphocytosis that lasted for several weeks and then remitted spontaneously. Even though the results of the studies were not diagnostic, the unique uptake pattern on PET/CT and the histology might be related to the cause of the illness and should be studied further to assess the association with classic FUO.

Identification of Interleukin 1-Responsive Genes in Human Chondrosarcoma SW1354 cells by cDNA Microarray Technology / 영남의대학술지

BACKGROUND: Accumulating evidence shows that interleukin(IL)-1 plays a critical role in inflammation and connective tissue destruction observed in both osteoarthritis and rheumatoid arthritis. IL-1 induces gene expression related to cytokines, chemokines and matrix metalloproteinases by activation of many different transcription factors. MATERIALS AND METHODS: The chondrosarcoma cell line, SW1353, is known to be a valuable in vitro system for investigating catabolic gene regulation by IL-1beta in chondrocytic cells. To explore and analyze the changes in gene expression by IL-1 responsible for arthritis, SW1353 was treated with IL-1 for 1, 6 and 24 h and then total RNAs were purified for each time. The changes in gene expression were analyzed with 17k human cDNA microarrays and validated by semi-quantitative RT-PCR. RESULTS: Greater than a two-fold change was observed in 1,200 genes including metallothioneins, matrix metalloproteinases, extracellular matrix proteins, antioxidant proteins, cytoskeleton proteins, cell cycle regulatory proteins, proteins for cell growth and apoptosis, signaling proteins and transcription factors. These changes appeared to be correlate with the pathophysiological changes observed in early osteoarthritis. CONCLUSION: cDNA microarray analysis revealed a marked variability in gene expression, and provided insight into the overall molecular changes. The result of this study provide initial information for further studies to identify therapeutic targets in osteoarthritis pathogenesis.

Management of gout / 대한내과학회지

No abstract available.

Evaluation of Patients with Rheumatoid Arthritis by Tc-99m MIBI Imaging / 대한핵의학회잡지

PURPOSE: We investigated whether Tc-99m MIBI imaging is useful to predict the response of drug treatment in patients with rheumatoid arthritis. MATERIALS AND METHODS: 24 patients (15 women and 9 men, age 49 +/- 12 year) rheumatoid arthritis and treated with disease modifying antirheumatic drugs (DMARDs) were included in this study. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and Tc-99m MIBI scan was obtained before drug treatment. Quantitative analysis of uptake in diseased joints was performed and expressed as joint-to background ratio (J/B) and percent retention (%R) of Tc-99m MIBI. Clinical symptoms were evaluated and graded from 0 (no) to 3 (severe) regarding to presence of tenderness and swelling. RESULTS: J/B of the diseased joints were significantly correlated with ESR and CRP (p< 0.05). A highly significant correlation was found between the improvement of clinical symptoms and %R of Tc-99m MIBI (p< 0.05). CONCLUSION: The results demonstrate that Tc-99m MIBI scan may be used to predict the therapeutic response in patients with rheumatoid arthritis.

Lipid profiles in patients with systemic lupus erythematosus / 대한내과학회지

BACKGROUND: The aims of this study were the identification of the abnormalities in lipid profiles and the correlations between serum lipid profiles and inflammatory parameters in patients with systemic lupus erythematosus. METHODS: The subjects were 50 patients with systemic lupus erythematosus who have been treated in rheumatology clinic, Yeungnam University Hospital. Serum lipids and apolipoproteins were measured and compared with those of age- and sex-matched controls. In systemic lupus erythematosus group, disease activities were assessed by systemic lupus erythematosus disease activity index and erythrocyte sedimentation rate. RESULTS: All lipid profiles were within normal range but most of lipoprotein levels were higher in patients with systemic lupus erythematosus than controls. Triglyceride, low-density lipoprotein and very-low-density lipoprotein were statistically significant (p=0.001, p=0.023, and p=0.001 respectively). Total cholesterol and low-density lipoprotein were significantly increased in systemic lupus erythematosus patients with proteinuria (>or=100 mg/dL/24hr) than in patients without proteinuria. Total cholesterol and low-density lipoprotein had positive correlations and apolipoprotein A-II had negative correlation with systemic lupus erythematosus disease activity index. Low-density lipoprotein and apolipoprotein B had positive correlations, high-density lipoprotein and apolipoprotein A-II had negative correlations with erythrocyte sedimentation rate. But differences of lipid profiles according to the duration of disease and total doses of steroid were not significant. CONCLUSION: This study showed that triglyceride, low-density lipoprotein, and very-low-density lipoprotein in patients with systemic lupus erythematosus were higher than controls. Total cholesterol and LDL in patients with SLE had positive correlations with disease activities.

Evaluation of Lung Epithelial Permeability in Patients with Type 2 Diabetes Mellitus using 99mTc-DTPA Aerosol Scintigraphy / 대한내분비학회지

BACKGROUND: Diabetes mellitus is often accompanied by complicated microangiopathy, such as, retinopathy, nephropathy, peripheral neuropathy, cardiovascular autonomic neuropathy or macroangiopathy, as well as by coronary artery disease and cerebrovascular disease. However, there have been few reports concerning the pulmonary involvement of diabetes. Recently, capillary basement membrane thickening, nonenzymatic glycosylation of tissue proteins, abnormalities of endothelial cells and increased damage by free radicals were reported as the underlying basis for the reduced lung permeability. 99mTc-DTPA aerosol scintigraphy is a noninvasive, accurate method, which evaluates the permeability of lung epithelial membranes. The clearance rate of 99mTc-DTPA in lungs may correlate inversely with the lung's epithelial permeability. We investigated the relationship between microangiopathies and the lung epithelial permeability in patients with diabetes using 99mTc-DTPA aerosol scintigraphy. METHODS: The study group comprised of 33 patients with type 2 diabetes mellitus, with no clinical evidence of past or present respiratory disease. The patients were divided into two groups in relation to the complications. Group 1: 16 patients with more than one of the complications of retinopathy, nephropathy, cardiovascular autonomic neuropathy and/or peripheral neuropathy, and comprised of 3 males and 13 females, with a mean age of 52.9 +/- 9.6 years. Group 2: 17 patients with no complications, and comprised of 5 males and 12 females with a mean age of 52.8 +/- 11.5 years. Group 3: as a control group, comprised of 11 healthy people: 4 males 4 and 7 females with a mean age of 44.2 +/- 12.5 years. 99m-Tc-DTPA aerosol scintigraphy was performed in the subjects by inhalation of 30 mCi 99mTc-DTPA aerosol and oxygen (9 l/min) using an aero-vent jet nebulizer as the lung delivery system. To evaluate the diabetic complications, CAN (Cardiovascular Autonomic Neuropathy), and NCV (Nerve Conduction Velocity) tests for peripheral neuropathy, fundoscopy for retinopathy and 24 hours urine microalbumin for nephropathy were performed. RESULTS: The mean durations of diabetes in Groups 1 and 2 were 11.1 +/- 4.7 years and 3.8 +/- 2.1 years, respectively (p<0.05). The mean clearance rates of 99mTc-DTPA were found to be 72.1 +/- 19.5min, 52.6 +/- 19.7 min, and 47.1 +/- 10.9 min for Groups 1, 2, and 3, respectively. The mean clearance rate of Group 1 was significantly longer than for Groups 2 and 3 (p<0.05). In other words, the pulmonary epithelial permeability was reduced in diabetic patients with complications compared to the patients without complication and/or the normal controls. Significant positive correlation was found between the pulmonary clearance rate of 99mTc-DTPA, and peripheral neuropathy and cardiovascular autonomic neuropathy (p<0.05). Conclusions: The lungs may be a target organ for diabetes, and impaired pulmonary epithelial permeability seems to be closely related to other diabetic microangiopathies. Therefore, we recommend that 99mTc-DTPA aerosol scintigraphy be used as a technique for assessing lung injury in diabetic patients.

Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To investigate the prevalence of autonomic dysfunction and to evaluate the relationship between autonomic dysfunction and clinical parameters in patients with systemic lupus erythematosus (SLE). METHODS: Fifty-eight patients with SLE who met the American College of Rheumatology criteria for SLE and forty-five healthy controls were selected at our hospital. Cardiovascular autonomic nervous function (CAN) test, including heart rate variation in deep breathing, Valsalva maneuver and orthostatic change and blood pressure response to standing, handgrip, was done in patient group and controls. Erythrocyte sedimentation rate (ESR), antinuclear antibody, anti-dsDNA antibody, complete blood count, complement and disease duration of patients were retrospectively reviewed and disease activity was assessed by Mexican SLE disease activity index (MEX-SLEDAI). RESULTS: The frequency of parasympathetic damage was 51.7% in patients with SLE and 15.6% in controls. There was significant difference between 2 groups in heart rate variation in deep breathing. No significant correlations were observed between autonomic dysfunction and ESR, antinuclear antibody, anti-dsDNA antibody, thrombocytopenia, complement, disease duration of patients, but there was slightly positive correlation between number of abnormal parasympathetic function test and MEX-SLEDAI (r=0.32, p<0.05). CONCLUSION: The prevalence of autonomic dysfunction was high in SLE patients and there was high frequency in patients with high disease activity. Prospective studies are needed to determine the clinical significance of autonomic dysfunction in the morbidity and mortality of SLE.

Autonomic Nervous Dysfunction in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the frequency of autonomic nervous dysfunction and assess the factors associated with autonomic nervous dysfunction in patients with rheumatoid arthritis (RA). METHODS: Three battery of cardiovascular autonomic nervous function tests (CAN test);heart rate response to Valsalva maneuver,deep breathing and standing up,were performed in 68 patients who met the 1987 American Rheumatism Association revised criteria for RA and 58 healthy controls.Autonomic nervous dysfunction was defined as 2 of 3 CAN tests were abnormal. Clinical and radiographic variables such as age,sex,disease duration,erythrocyte sedimentaton rate (ESR)and bone destruction,were analyzed in patients with or without autonomic nervous dysfunction. RESULTS: In patients with RA,the frequency of autonomic nervous dysfunction was higher than healthy controls (50.8%in RA vs 15.5%in healthy controls,p<0.05).Age,sex,disease duration,ESR and bone destruction were not associated with autonomic nervous dysfunction in patients with RA CONCLUSIONS: This results suggest that autonomic nervous dysfunction may be a significant feature in patients with RA.