{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:25:32Z","timestamp":1790623532058,"version":"4.1.0"},"reference-count":72,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,10,24]],"date-time":"2016-10-24T00:00:00Z","timestamp":1477267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000341","name":"Arthritis Research UK","doi-asserted-by":"publisher","award":["196633"],"award-info":[{"award-number":["196633"]}],"id":[{"id":"10.13039\/501100000341","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Key points<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with an increased risk of cardiovascular mortality.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity heighten cardiovascular risk, althogh whether such autonomic dysfunction is present in RA is not known.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>In the present study, we observed an increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in patients with RA compared to matched controls.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Pain was positively correlated with sympathetic nerve activity and negatively correlated with cardiac baroreflex sensitivity.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The pattern of autonomic dysfunction that we describe may help to explain the increased cardiovascular risk in RA, and raises the possibility that optimizing pain management may resolve autonomic dysfunction in RA.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with increased cardiovascular morbidity\/mortality and an incompletely understood pathophysiology. In animal studies, central and blood borne inflammatory cytokines that can be elevated in RA evoke pathogenic increases in sympathetic activity and reductions in baroreflex sensitivity (BRS). We hypothesized that muscle sympathetic nerve activity (MSNA) was increased and BRS decreased in RA. MSNA, blood pressure and heart rate (HR) were recorded in age\u2010 and sex\u2010matched RA\u2010normotensive (<jats:italic>n\u00a0=\u00a0<\/jats:italic>13), RA\u2010hypertensive patients (RA\u2010HTN; <jats:italic>n\u00a0=\u00a0<\/jats:italic>17), normotensive (NC; <jats:italic>n\u00a0=\u00a0<\/jats:italic>17) and hypertensive controls (HTN; <jats:italic>n\u00a0=\u00a0<\/jats:italic>16). BRS was determined using the modified Oxford technique. Inflammation and pain were determined using serum high sensitivity C\u2010reactive protein (hs\u2010CRP) and a visual analogue scale (VAS), respectively. MSNA was elevated similarly in RA, RA\u2010HTN and HTN patients (32\u00a0\u00b1\u00a09, 35\u00a0\u00b1\u00a014, 37\u00a0\u00b1\u00a08\u00a0bursts\u00a0min<jats:sup>\u20131<\/jats:sup>) compared to NC (22\u00a0\u00b1\u00a09\u00a0bursts\u00a0min<jats:sup>\u20131<\/jats:sup>; <jats:italic>P\u00a0=\u00a0<\/jats:italic>0.004). Sympathetic BRS was similar between groups (<jats:italic>P\u00a0=\u00a0<\/jats:italic>0.927), whereas cardiac BRS (cBRS) was reduced in RA, RA\u2010HTN and HTN patients [5(3\u20138), 4 (2\u20137), 6 (4\u20139)\u00a0ms\u00a0mmHg<jats:sup>\u20131<\/jats:sup>] compared to NC [11 (8\u201315)\u00a0ms\u00a0mmHg<jats:sup>\u20131<\/jats:sup>; <jats:italic>P\u00a0=\u00a0<\/jats:italic>0.002]. HR was independently associated with hs\u2010CRP. Increased MSNA and reduced cBRS were associated with hs\u2010CRP although confounded in multivariable analysis. VAS was independently associated with MSNA burst frequency, cBRS and HR. We provide the first evidence for heightened sympathetic outflow and reduced cBRS in RA that can be independent of hypertension. In RA patients, reported pain was positively correlated with MSNA and negatively correlated with cBRS. Future studies should assess whether therapies to ameliorate pain and inflammation in RA restores autonomic balance and reduces cardiovascular events.<\/jats:p><\/jats:sec>","DOI":"10.1113\/jp272944","type":"journal-article","created":{"date-parts":[[2016,8,26]],"date-time":"2016-08-26T08:27:39Z","timestamp":1472200059000},"page":"967-981","source":"Crossref","is-referenced-by-count":70,"title":["Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in rheumatoid arthritis"],"prefix":"10.1113","volume":"595","author":[{"given":"Ahmed M.","family":"Adlan","sequence":"first","affiliation":[{"name":"College of Life &amp; Environmental Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian F. 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H.","family":"Lip","sequence":"additional","affiliation":[{"name":"University of Birmingham Centre of Cardiovascular Sciences City Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George D.","family":"Kitas","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Dudley Group NHS Foundation Trust Russells Hall Hospital  Dudley West Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Fisher","sequence":"additional","affiliation":[{"name":"College of Life &amp; Environmental Sciences University of Birmingham  Birmingham 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