Suppression of the GH/IGF-I Axis In Women With Rheumatoi

这是一项在NIH临床中心进行的在绝经前和围绝经期女性中进行的研究，这些女性类风湿性关节炎（RA）发作持续时间少于3年，并且是活动性炎症性疾病。在这项研究中，我们假设RA患者全身释放的过量炎性细胞因子抑制GH/IGF-1轴的活性，并且内分泌免疫功能紊乱的综合作用有助于身体组成、内分泌代谢和血管功能的变化，这些变化被认为易诱发RA相关的肌肉减少症、骨质减少症和心血管风险增加。在本研究中，RA患者和对照受试者入住临床中心36小时，以评估GH/IGF-I轴、细胞因子、身体组成、内分泌代谢和心血管功能以及生活质量。我们进行了这项研究，比较RA患者与健康，年龄和BMI匹配的女性的基线内分泌和炎症参数。如果假设得到满足，我们将考虑进行一项随访研究，在该研究中，我们将招募一组相似的RA患者，在基线和使用一种可用的TNF-α受体拮抗剂治疗6个月后，在不存在和存在DHEA或其他CAM干预（例如冥想）的情况下，评估上述结局指标。我们共评估了7名RA患者和10名匹配的对照受试者;招募已结束，研究终止。自上次报告以来，我们测量了24小时DHEA和细胞因子分泌，后者使用多重测定系统。激素、身体组成和其他数据已制成表格并进行分析，目前正在编写一份手稿。细胞因子数据已制成表格，目前正在分析，预计将发表第二份手稿。

This is a study in pre- and peri-menopausal women with onset of rheumatoid arthritis (RA) of less than 3 years duration, and active, inflammatory disease, that was conducted at the NIH Clinical Center. In this investigation, we hypothesized that the excess of systemically released inflammatory cytokines in RA patients suppresses activity of the GH/IGF-1 axis, and that the combined effects of disordered endocrine-immune function contribute to changes in body composition, endocrine-metabolic and vascular functions thought predisposing to RA-related sarcopenia, osteopenia and increased cardiovascular risk. In this study, RA patients and control subjects were admitted to the Clinical Center for a 36 hour period for assessments of the GH/IGF-I axis, cytokines, body composition, endocrine- metabolic and cardiovascular functions, and quality of life. We conducted this study to compare baseline endocrine and inflammatory parameters in RA patients with those in healthy, age- and BMI-matched women. Should the hypotheses be satisfied, we shall consider conducting a follow-up study, in which we would enroll a similar group of RA patients to evaluate the above outcome measures at baseline and after six months of treatment with one of the available TNF-alpha receptor antagonists, both in the absence and presence of DHEA or other CAM intervention (e.g. meditation). We evaluated a total of 7 RA patients and 10 matched control subjects; and enrollment has been ended, and the study terminated. Since the last report, we have measured 24 hour DHEA and cytokine secretion, the latter using a mulitplex assay system. Hormone, body composition and other data have been tabulated and analysed and a manuscript is in preparation. Cytokine data have been tabulated and are currently being analysed in anticipation of preparaing a second manuscript.