Adrenal secretion of cortisol in patients with rheumatoid arthritis

Journal/Book: Z Rheumatol 1999; 58: 302. 1999;

Abstract: G. Neeck; Kerckhoff Klinik Rheumatologie Stiftung W. G. Kerckhoff Herz- und Rheumazentrum Bad Nauheim Since the pioneering publication of Hench and coworkers (1) which demonstrated the anti-inflammatory effects of cortisone in rheumatoid arthritis (RA) the question arose whether the glucocorticoid therapy was successful because it was replenishing an underlying deficiency of endogenous cortisol production. However the results of a number of studies of the next decades proved disappointing. Determining cortisol in blood or urine showed conflicting results finding cortisol secretion elevated normal or decreased. In 1990 our group published (2) plotted circadian rhythms of plasma cortisol and ACTH in untreated RA patients with different inflammatory activities (ESR<40 mm/h low; 40-80 mm/h medium; > 80 mm/h high). In patients with low to medium disease activity circadian extremes of cortisol occurred earlier in the day to normal controls. Patients with low level disease activity had a lower cortisol profile while in patients with high disease activity cortisol secretion was elevated with loss of circadian rhythm. Regression analysis of the arithmetic mean of the cortisol values of the 24 h cycle related to the parameter of inflammation ESR proved a highly significant correlation. But compared to values of healthy controls only patients with high inflammatory activity had higher cortisol values than the healthy controls. So it seems to be that in patients with low to medium disease activity cortisol production in RA was inappropriate low. Further studies showed a correlation of cortisol also to cytokines especially IL-6 in RA patients reflecting a stimulation of the HPA axis by IL-6 via the neuroendocrine immune loop (3). Very recent findings proved the observation that rheumatoid factor (RF) positive RA is quite different to rheumatoid factor negative RA with respect of the cortisol leveling. ... le

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