Hypothalamic-pituitary-adrenal axis function in rheumatoid arthritis

ABSTRACT

This study was conducted on 50 individuals, 35 patients suffering from rheumatoid arthritis [RA] diagnosed according to the revised American Rheumatism Association criteria and receiving nonsteroidal anti-inflammatory drugs [NSAID] and 15 apparently healthy individuals as a reference group. Each individual was subjected to full history taking, clinical examination complete blood count, erythrocyte sedimentation rate, rheumatoid factor, plasma adrenocoticotrophic hormone [ACTH], serum cortisol [AM. PM] and serum interleukin-1 B [IL-IB]. ACTH levels were significantly higher in RA patients [mean +/- SD 43.6 +/- 26.9 pg/mi] than in the reference group [mean +/- SD 30.8 +/- 19.2 pg/ml. Serum cortisol levels [both AM and PM values] were reduced in RA patients [mean +/- SD 10.3 +/- 7.6 ug/dI and 5.3 +/- 3.5 ug/d1] than in reference group [mean j SD 12.6 +/- 3.4 ug/dl and 6.2 +/- 1.7 ug/dl and this reduction was evident in patients with active RA, grade III [mean +/- SD 6.8 +/- 2.4 ug/dl and 3.8 +/- 1.5ug/dl] and grade IV [mean +/- SD 2.36 +/- 2.1 ug/dI and 1.9 +/- 2.3 ug/dl. Serum levels of IL-lB were elevated in RA patients [mean +/- SD 7.8 +/- 8.4 pg/mi] than in reference group [mean +/- SD 2.5 +/- 1.5 pg/m1]. These findings suggest that RA patients have an abnormality of the HPA axis function. This hypothalamic abnormality may be an additional unrecognized factor in the pathogenesis of RA