RESUMO
OBJECTIVE: To test the hypothesis that cortisol elimination from plasma can contribute to relatively low cortisol in premenopausal women with rheumatoid arthritis (RA). METHODS: Twelve premenopausal female patients with RA (39.8 (1.8) years) and nine healthy control women matched for age and body mass index (42 (3.3) years) were enrolled in the study. None of the patients had previously been receiving treatment with glucocorticoids. After dexamethasone suppression (2 mg by mouth) the evening before the study, 20 mg of hydrocortisone was given. Blood and saliva samples were drawn six hours after injection of hydrocortisone. Plasma and salivary cortisol were measured. RESULTS: Dexamethasone administration suppressed plasma cortisol concentrations to an almost undetectable level in all subjects, except one with RA. In this subject, a raised concentration of plasma cortisol was verified by repeated analysis despite the fact that cortisol concentration in the saliva sample measured simultaneously was not raised. No significant difference in the disappearance curve of cortisol in plasma or in salivary cortisol levels was found between the patients with RA and the healthy controls. CONCLUSIONS: The profile of disappearance of total cortisol from plasma, and salivary cortisol levels during the elimination phase after its intravenous administration, are unchanged in premenopausal women with RA. Alterations in cortisol clearance are not likely to have a role in cortisol availability in patients with RA.
Assuntos
Artrite Reumatoide/metabolismo , Hidrocortisona/sangue , Pré-Menopausa/metabolismo , Adulto , Estudos de Casos e Controles , Dexametasona , Feminino , Glucocorticoides , Humanos , Hidrocortisona/análise , Saliva/químicaAssuntos
Gota/sangue , Homocisteína/sangue , Adulto , Biomarcadores/sangue , Cromatografia Líquida de Alta Pressão , Feminino , Gota/diagnóstico , Gota/tratamento farmacológico , Supressores da Gota/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
The association of SLE with tuberculosis (TB) was studied in a group of 388 patients with SLE monitored between 1953-1994. TB was diagnosed in 14 patients (3.6%). The occurrence of septic fevers in SLE patients that did not respond to glucocorticoid therapy indicated the possibility of complication with TB. SLE-associated TB included miliary and far-advanced pulmonary and extrapulmonary forms. Three patients from our group died due to myco-bacterial infection and one patient died of active SLE and TB. The treatment was successful in nine patients. Early diagnosis and appropriate management are mandatory in SLE associated TB, which otherwise may have a potentially fatal outcome.
