Tumor necrosis factor inhibition may improve autonomic dysfunction in rheumatoid arthritis

Autonomic nervous system (ANS) involvement in rheumatoid arthritis (RA) has been well recognized. Symptoms of autonomic dysfunction are absent and not specific, but diagnosis of ANS dysfunction by non-invasive means is warranted to prevent severe consequences. However, there is no study demonstrating therapeutic efficacy on autonomic neuropathy (AN) in RA. This is the first reported observation of improvement in AN with the TNF-α inhibitor (TNFi), infliximab in RA. We report here a case of a 57-year-old, seropositive RA female with severe disease activity, investigated for AN. Non-invasive tests based on peripheral sympathetic and cardiovascular autonomic neuropathy (CAN) function were used for accurate assessment of autonomic function. The patient was treated with infliximab 3 mg/kg intravenous infusion at weeks 0, 2, and 6. An improvement in autonomic dysfunction was noted after 6 weeks of therapy in both sympathetic and parasympathetic CAN.