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Experimentally challenged reactivity of the hypothalamic pituitary adrenal axis in patients with recently diagnosed rheumatoid arthritis.
J Rheumatol. 2001 Jul; 28(7):1496-504.JR

Abstract

OBJECTIVE

There is evidence that the hypothalamic pituitary adrenal (HPA) axis is subresponsive in patients with rheumatoid arthritis (RA). We assessed HPA axis responses to experimental stressors mimicking daily life challenges in patients with RA to determine whether HPA axis activity is associated with Th1 and Th2 activity.

METHODS

ACTH and cortisol responses in reaction to the succession of a bicycle ergometer task, a cold pressor task, and a computerized Stroop Color-Word interference test, as well as basal Th1 and Th2 cell activity, were assessed in 29 patients (21 female, 8 male) with recently diagnosed RA (mean disease duration 29 wks, range 5-69), mean age 55.7 years, none receiving glucocorticoid treatment, and 30 (20 female, 10 male) healthy age and sex matched controls (mean age 54.1 yrs).

RESULTS

Mean ACTH and cortisol levels did not differ between the groups (p > 0.10). Patients tended to have a less pronounced ACTH response (F2.50 = 2.7, p = 0.08) and had a significantly smaller cortisol response (P F2.50 = 6.1, p < 0.01) than healthy controls in reaction to the stressors. This difference in cortisol response was reduced, but remained significant when ACTH responsiveness was accounted for by entering it as a covariate (P F2.49 = 3.7, p = 0.03). ACTH and cortisol levels and responses were not associated (all p > 0.19) with basal interferon-gamma and interleukin 4 as reflections of Th1 and Th2 cell activity, respectively. HPA axis activity was not linked to current disease activity.

CONCLUSION

Our findings show reduced HPA axis responsiveness in RA patients with recent diagnosis receiving longterm medication that is suggested to be located both at a hypothalamic/pituitary and at an adrenal level. It appears that common HPA axis activity accomplishes low amounts of cortisol release, which makes it difficult to determine an influence of endogenous cortisol changes on the Th1/Th2 balance.

Authors+Show Affiliations

Department of Health Psychology, Utrecht University, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11469453

Citation

Dekkers, J C., et al. "Experimentally Challenged Reactivity of the Hypothalamic Pituitary Adrenal Axis in Patients With Recently Diagnosed Rheumatoid Arthritis." The Journal of Rheumatology, vol. 28, no. 7, 2001, pp. 1496-504.
Dekkers JC, Geenen R, Godaert GL, et al. Experimentally challenged reactivity of the hypothalamic pituitary adrenal axis in patients with recently diagnosed rheumatoid arthritis. J Rheumatol. 2001;28(7):1496-504.
Dekkers, J. C., Geenen, R., Godaert, G. L., Glaudemans, K. A., Lafeber, F. P., van Doornen, L. J., & Bijlsma, J. W. (2001). Experimentally challenged reactivity of the hypothalamic pituitary adrenal axis in patients with recently diagnosed rheumatoid arthritis. The Journal of Rheumatology, 28(7), 1496-504.
Dekkers JC, et al. Experimentally Challenged Reactivity of the Hypothalamic Pituitary Adrenal Axis in Patients With Recently Diagnosed Rheumatoid Arthritis. J Rheumatol. 2001;28(7):1496-504. PubMed PMID: 11469453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experimentally challenged reactivity of the hypothalamic pituitary adrenal axis in patients with recently diagnosed rheumatoid arthritis. AU - Dekkers,J C, AU - Geenen,R, AU - Godaert,G L, AU - Glaudemans,K A, AU - Lafeber,F P, AU - van Doornen,L J, AU - Bijlsma,J W, PY - 2001/7/27/pubmed PY - 2002/1/5/medline PY - 2001/7/27/entrez SP - 1496 EP - 504 JF - The Journal of rheumatology JO - J Rheumatol VL - 28 IS - 7 N2 - OBJECTIVE: There is evidence that the hypothalamic pituitary adrenal (HPA) axis is subresponsive in patients with rheumatoid arthritis (RA). We assessed HPA axis responses to experimental stressors mimicking daily life challenges in patients with RA to determine whether HPA axis activity is associated with Th1 and Th2 activity. METHODS: ACTH and cortisol responses in reaction to the succession of a bicycle ergometer task, a cold pressor task, and a computerized Stroop Color-Word interference test, as well as basal Th1 and Th2 cell activity, were assessed in 29 patients (21 female, 8 male) with recently diagnosed RA (mean disease duration 29 wks, range 5-69), mean age 55.7 years, none receiving glucocorticoid treatment, and 30 (20 female, 10 male) healthy age and sex matched controls (mean age 54.1 yrs). RESULTS: Mean ACTH and cortisol levels did not differ between the groups (p > 0.10). Patients tended to have a less pronounced ACTH response (F2.50 = 2.7, p = 0.08) and had a significantly smaller cortisol response (P F2.50 = 6.1, p < 0.01) than healthy controls in reaction to the stressors. This difference in cortisol response was reduced, but remained significant when ACTH responsiveness was accounted for by entering it as a covariate (P F2.49 = 3.7, p = 0.03). ACTH and cortisol levels and responses were not associated (all p > 0.19) with basal interferon-gamma and interleukin 4 as reflections of Th1 and Th2 cell activity, respectively. HPA axis activity was not linked to current disease activity. CONCLUSION: Our findings show reduced HPA axis responsiveness in RA patients with recent diagnosis receiving longterm medication that is suggested to be located both at a hypothalamic/pituitary and at an adrenal level. It appears that common HPA axis activity accomplishes low amounts of cortisol release, which makes it difficult to determine an influence of endogenous cortisol changes on the Th1/Th2 balance. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/11469453/Experimentally_challenged_reactivity_of_the_hypothalamic_pituitary_adrenal_axis_in_patients_with_recently_diagnosed_rheumatoid_arthritis_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&amp;pmid=11469453 DB - PRIME DP - Unbound Medicine ER -