Inadequately low serum levels of steroid hormones in relation to interleukin-6 and tumor necrosis factor in untreated patients with early rheumatoid arthritis and reactive arthritis
Inadequately low serum levels of steroid hormones in relation to interleukin-6 and tumor necrosis factor in untreated patients with early rheumatoid arthritis and reactive arthritis
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DOI：
10.1002/art.10177
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发表时间：
2002-03-01
影响因子：
--
通讯作者：
Leirisalo-Repo, M
中科院分区：
文献类型：
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作者：
Straub, RH;Paimela, L;Leirisalo-Repo, M
Objective.比较早期类风湿性关节炎（RA）和反应性关节炎（ReA）未治疗患者与健康对照组的类固醇激素水平与细胞因子的关系，并研究皮质醇或脱氢表雄酮（DHEA）水平与其他肾上腺激素的关系。在一项回顾性研究中，我们检测了34例RA患者、46例ReA患者和112例健康受试者的血清白细胞介素-6（IL-6）、肿瘤坏死因子（TINT）、促肾上腺皮质激素（ACTH）、皮质醇、17-羟孕酮（17-OH-孕酮）、雄烯二酮（ASD）、DHEA和MEA硫酸盐（DHEAS）水平。RA患者血清IL-6、TNF、皮质醇和DHEA水平高于ReA患者和健康受试者，但ACTH和DREAS无差异。RA和ReA患者ACTH、皮质醇、ASD、DREAS和17-OH-孕酮水平与IL-6和TNT水平呈显著负相关。此外，RA患者关节肿胀数量与血清皮质醇/血清IL-6比值呈负相关（R-Rank =-0.582，P = 0.001），ReA患者关节肿胀数量与血清皮质醇/血清IL-6比值呈负相关（R-Rank =-0.417，P = 0.011）。RA患者双手平均握力与血清皮质醇/IL-6比值呈正相关（R-Rank = 0.472，P = 0.010）。此外，在这些未经治疗的RA和ReA患者中，与DHEA和皮质醇相关的17-OH-孕酮、ASD和DHEAS的分泌相对减少。这表明在这些炎症性疾病的早期阶段，非硫酸脱氢表雄酮和皮质醇相对于所有其他测量的肾上腺类固醇激素的相对优势。这项研究表明，与健康受试者相比，未治疗的早期RA和ReA患者的ACTH和皮质醇水平相对较低，与IL-6和TNF水平相关。该研究进一步表明，相对于其他肾上腺激素，如DHEAS，DHEA和皮质醇相对增加。这项研究强调，肾上腺类固醇分泌不足，低的炎症。虽然激素水平的变化是相似的RA和ReA，类固醇生成的改变是更明显的RA患者比ReA患者。
Objective. To compare levels of steroid hormones in relation to cytokines and to study levels of cortisol or dehydroepiandrosterone (DHEA) in relation to other adrenal hormones in untreated patients with early rheumatoid arthritis (RA) and reactive arthritis (ReA) compared with healthy controls.Methods. In a retrospective study with 34 RA patients, 46 ReA patients, and 112 healthy subjects, we measured serum levels of interleukin-6 (IL-6), tumor necrosis factor (TINT), adrenocorticotropic hormone (ACTH), cortisol, 17-hydroxyprogesterone (17-OH-progesterone), androstenedione (ASD), DHEA, and MEA sulfate (DHEAS).Results. RA patients had higher serum levels of IL-6, TNF, cortisol, and DHEA compared with ReA patients and healthy subjects, but no difference was noticed with respect to ACTH and DREAS. However, in RA and ReA patients compared with healthy subjects', levels of ACTH, cortisol, ASD, DREAS, and 17-OH-progesterone were markedly tower in relation to levels of IL-6 and TNT. Furthermore, the number of swollen joints correlated inversely with the ratio of serum cortisol to serum IL-6 in RA (R-Rank = -0.582, P = 0.001) and, to a lesser extent, in ReA (R-Rank = -0.417, P = 0.011). In RA patients, the mean grip strength of both hands was positively correlated with the ratio of serum cortisol to serum IL-6 (R-Rank = 0.472, P = 0.010). Furthermore, in these untreated patients with RA and ReA, there was a relative decrease in the secretion of 17-OH-progesterone, ASD, and DHEAS in relation to DHEA and cortisol. This indicates a relative predominance of the nonsulfated DHEA and cortisol in relation to all other measured adrenal steroid hormones in the early stages of these inflammatory diseases.Conclusion. This study indicates that levels of ACTH and cortisol are relatively low in relation to levels of IL-6 and TNF in untreated patients with early RA and ReA compared with healthy subjects. The study further demonstrates that there is a relative increase of DHEA and cortisol in relation to other adrenal hormones, such as DHEAS. This study emphasizes that adrenal steroid secretion is inadequately low in relation to inflammation. Although changes in hormone levels are similar in RA and ReA, alteration of steroidogenesis is more pronounced in RA patients than in ReA patients.