Änderungen des autonomen Nervensystems bei rheumatoider Arthritis

Zusammungfassung

Die rheumatoide Arthritis (RA) ist eine chronische Erkrankung, deren Auslöser und Verlaufsfaktoren noch nicht vollends geklärt sind. Durch intensive Forschung ist bisher bekannt, dass vielmehr verschiedene Faktoren an der Entstehung einer entzündlichen Rheumaerkrankung beteiligt sind. Doch neben genetischen Faktoren scheinen auch eine Dysregulation neuroimmunologischer Interaktionen, insbesondere Änderungen des autonomen Nervensystems (ANS) bei der Entstehung der Krankheit eine Rolle zu spielen. Aus Studien kann man entnehmen, dass das ANS auf die Krankheitsaktivität der RA Einfluss nehmen und das Risiko für Herzkreislauferkrankungen und Mortalität erhöhen kann. Die autonome Aktivität der RA-Patienten in Ruhe ist durch eine signifikant erhöhte Herzfrequenz, ein Überwiegen des Sympathikus im Verhältnis zum Parasympathikus sowie eine signifikant ernie­drigte Parasympathikusaktivität gekennzeichnet. Die Stressantwort der Patienten ist häufig pathologisch und durch signifikante Hypoaktivität des Sympathikus und Hyporeaktivität des Parasympathikus charakterisiert. Die Studienlage zeigt die klinische Relevanz einer autonomen Dysregulation bei RA, für ein besseres Verständnis sind jedoch noch weitere klinische und experimentelle Untersuchungen des ANS bei RA notwendig.

Abstract

Rheumatoid arthritis (RA) is a chronic rheumatic disease of unknown aetiology and variable severity. It is now well known that several risk factors are involved in its pathogenesis, e. g., genetic as well as environmental factors, including a distortion of the neuro-immune interaction. A modulation of autonomic nervous system (ANS) function is suggested to play an important role in the pathogenesis of RA. Many studies have clearly shown that ANS dysregulation is associated with an elevated risk of cardiovascular disease leading to an increased mortality in RA. Disturbed function of ANS in RA patients is characterised by an increased heart rate and a prevalence of sympathetic over parasympathetic activity. However, more studies are warranted to further explore the pathophysiological implications of ANS function on onset and activity of chronic autoimmune diseases.

Schlüsselwörter

autonomes Nervensystem - rheumatoide Arthritis - Sympathikus - Parasympathikus - Krankheitsaktivität

Key words

autonomic nervous system - rheumatoid arthritis - sympathetic activity - parasympathetic activity - disease activity

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