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. 2022 Sep;42(9):1555-1564.
doi: 10.1007/s00296-022-05122-3. Epub 2022 Apr 21.

Perspectives on applying immuno-autonomics to rheumatoid arthritis: results from an online rheumatologist survey

Dimitrios A Pappas  1   2 , Christine Brittle  3 , Andrew Concoff  4 , Andrew J Holman  5   6 , Dennis Takasugi  5 , Joel M Kremer  7
Affiliations

Perspectives on applying immuno-autonomics to rheumatoid arthritis: results from an online rheumatologist survey

Dimitrios A Pappas et al. Rheumatol Int. 2022 Sep.

Abstract

The term "immuno-autonomics" has been coined to describe an emerging field evaluating the interaction between stress, autonomic nervous system (ANS), and inflammation. The field remains largely unknown among practicing rheumatologists. Our objective was to evaluate the perspectives of rheumatologists regarding the role of stress in the activity and management of rheumatoid arthritis (RA). A 31-item survey was conducted with 231 rheumatologists. Rheumatologists were asked to assess the role of stress in rheumatoid arthritis (RA) disease activity and were provided with information regarding immuno-autonomics. They were asked to consider how immuno-autonomics resonated with their patient management needs. The majority of rheumatologists are eager to better understand non-response, believe that stress biology and ANS dysfunction interfere with disease activity, and embrace the theory that measurement of ANS via next-generation HRV may be able to evaluate autonomic dysfunction and the biology of stress. Rheumatologists are open to the idea that quantitative measurement of ANS function using next-generation HRV can be a helpful tool to RA practice. The majority agree that ANS state influences RA disease control and that quantitative measures of ANS state are helpful to RA practice. Rheumatologists also agree that patients with poor ANS function may be at risk for not responding adequately to conventional, biologic, or targeted synthetic DMARDs. Almost all would use an in-office test to quantitatively measure ANS using next-generation HRV. This study shows that rheumatologists are open to embracing evaluation of ANS function as a possible tool in the management and treatment of RA.

Keywords: Arthritis, Rheumatoid; Autonomic nervous system; Heart rate variability; Immuno-autonomics; Rheumatologists; Surveys and questionnaires.

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Figures

Fig. 1
Fig. 1
Model shown to survey respondents depicting connection between reduced HRV and suboptimal therapeutic immunosuppression
Fig. 2
Fig. 2
Survey response flow chart
Fig. 3
Fig. 3
Percentage of rheumatologists agreeing with statements about autonomic nervous system (ANS) state and heart rate variability (HRV)
Fig. 4
Fig. 4
Percentage of rheumatologists who would consider using a test to measure the state of the autonomic nervous system (ANS) for specific groups of patients
See this image and copyright information in PMC

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