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We thank Dr. Yalım and his colleagues for their interest and comments about our study which demonstrated that the cardiac autonomic nervous system was affected using 12-lead electrocardiography and Holter monitoring in patients with ankylosing spondylitis [1].
In their letter, Yalım et al. mentioned that anti-tumor necrosis factor (TNF) treatment may affect heart rate variability (HRV) parameters [2]. The effect of anti-TNF therapy on the cardiac autonomic nervous system is not clear in the literature. To our knowledge, there is no study in the literature except for one study [3]. In this study, response to anti-TNF treatment was evaluated by rapid HRV in patients with rheumatoid arthritis and psoriatic arthritis [3]. HRV is evaluated with 24-h and short (< 5 min) measurements. Twenty-four-hour evaluation provides the most valuable information for cardiac autonomic system [4]. In addition, we do not find it appropriate to generalize the results of this study to all inflammatory arthritis patients. In our study, although not written in the result section, when ankylosing spondylitis patients were analyzed by anti-TNF treatment, no statistical difference was found in any parameters (Tpe, Tpe/corrected QT ratio, heart rate variability, and heart rate turbulence parameters). Our ECG results were compatible with the literature [5].
In conclusion, we found that the cardiac autonomic nervous system was affected in patients with ankylosing spondylitis independently of anti-TNF treatment. Our findings may be a pathfinder for further studies.
References
Candemir M, Candemir B, Ertürk A (2020) Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring. Clin Rheumatol 39:2631–2639. https://doi.org/10.1007/s10067-020-05046-y
Yalım Z, Yalım SA, Onrat E (2020) Could anti-TNF treatment have affected HRV and HRT results? Clin Rheumatol. https://doi.org/10.1007/s10067-020-05407-7
Holman AJ, Ng E (2008) Heart rate variability predicts anti-tumor necrosis factor therapy response for inflammatory arthritis. Auton Neurosci 143(1–2):58–67. https://doi.org/10.1016/j.autneu.2008.05.005
Shaffer F, Ginsberg JP (2017) An overview of heart rate variability metrics and norms. Front Public Health 5:258. https://doi.org/10.3389/fpubh.2017.00258
Longo B, Kirchner LA, Simioni J, Campos APB, Skare TL (2019) Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients. Einstein (Sao Paulo) 17(2):eAO4539. https://doi.org/10.31744/einstein_journal/2019AO4539
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Candemir, M., Candemir, B. & Ertürk, A. Replying to the letter entitled “Could anti-TNF treatment have affected HRV and HRT results?”. Clin Rheumatol 40, 431 (2021). https://doi.org/10.1007/s10067-020-05447-z
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DOI: https://doi.org/10.1007/s10067-020-05447-z