Autonomic Neuropathy in Rheumatoid Arthritis

Abstract

The thermo-regulatory sweating response to immersion in warm water and the local sweating response to intradermal injection of acetyl choline and faradic stimulation have been tested in 18 patients with rheumatoid arthritis and peripheral neuropathy, in 8 patients with uncomplicated rheumatoid arthritis, and in 13 non-rheumatoid control subjects, in order to differentiate lesions of pre- and postganglionic fibers. In the control group, areas of deficient sweating were small and symmetrical. In most of the patients with rheumatoid arthritis and peripheral neuropathy, there was sweat loss in areas corresponding approximately to those of cutaneous sensory impairment: this loss was usually of the type seen with interruption of postganglionic fibers. i.e. absent thermo-regulatory and local responses. In some patients the sweat response was normal. In 4 patients with thermo-regulatory sweat loss there was a positive local response suggestive of a preganglionic lesion, but in all 4 the clinical neuropathy was recovering or had re covered, and it is possible that the observed sweating abnormality represented a recovering postganglionic lesion rather than a preganglionic lesion. Six of the 8 patients with uncomplicated rheumatoid arthritis showed sweat responses similar to those of the control subjects, but 2 had larger areas of sweat loss: the significance of this is uncertain. It is concluded that clinical sensory neuropathy in rheumatoid arthritis is usually accompanied by an autonomic neuropathy of postganglionic type corresponding to the sensory loss.