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Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate and its relation to clinical variables in inflammatory arthritis.

Dessein PH, Joffe BI, Stanwix AE, Moomal Z - Arthritis Res. (2001)

Bottom Line: In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls.Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men.We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Rheumatology, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa. Dessein@elink.co.za

ABSTRACT
Hypothalamic-pituitary-adrenal underactivity has been reported in rheumatoid arthritis (RA). This phenomenon has implications with regard to the pathogenesis and treatment of the disease. The present study was designed to evaluate the secretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEAS) and its relation to clinical variables in RA, spondyloarthropathy (Spa), and undifferentiated inflammatory arthritis (UIA). Eighty-seven patients (38 with RA, 29 with Spa, and 20 with UIA) were studied, of whom 54 were women. Only 12 patients (14%) had taken glucocorticoids previously. Age-matched, healthy women (134) and men (149) served as controls. Fasting blood samples were taken for determination of the erythrocyte sedimentation rate (ESR), serum DHEAS and insulin, and plasma glucose. Insulin resistance was estimated by the homeostasis-model assessment (HOMAIR). DHEAS concentrations were significantly decreased in both women and men with inflammatory arthritis (IA) (P < 0.001). In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls. Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men. After the ESR, previous glucocorticoid usage, current treatment with nonsteroidal anti-inflammatory drugs, duration of disease and HOMAIR were controlled for, the differences in DHEAS levels between patients and controls were markedly attenuated in women (P = 0.050) and were no longer present in men (P = 0.133). We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters. The role of hypoadrenalism in the pathophysiology of IA deserves further elucidation. DHEA replacement may be indicated in many patients with IA, even in those not taking glucocorticoids.

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Serum DHEAS concentrations in female controls according to their age.
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Figure 1: Serum DHEAS concentrations in female controls according to their age.

Mentions: The DHEAS concentrations in patients and controls are reported in Table 1 and Figs 1 to 4. DHEAS concentrations were significantly lower in both women and men with IA than in their respective controls, and in 14 women (26%) and 10 men (30%) with IA, these concentrations fell below the extreme ranges (Figs 1 and 2) found in age-matched controls. The values found for the various subsets of disease are given in Table 2. Multiple intergroup comparisons of DHEAS concentrations revealed no significant differences apart from higher levels in MSpa than in MUIA (P = 0.04). Even in patients with MSpa, DHEAS concentrations were lower than in male controls (4.61 ± 1.87 vs 6.19 ± 4.12 μmol/l, P < 0.001). This difference remained equally significant after age was controlled for.


Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate and its relation to clinical variables in inflammatory arthritis.

Dessein PH, Joffe BI, Stanwix AE, Moomal Z - Arthritis Res. (2001)

Serum DHEAS concentrations in female controls according to their age.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC30711&req=5

Figure 1: Serum DHEAS concentrations in female controls according to their age.
Mentions: The DHEAS concentrations in patients and controls are reported in Table 1 and Figs 1 to 4. DHEAS concentrations were significantly lower in both women and men with IA than in their respective controls, and in 14 women (26%) and 10 men (30%) with IA, these concentrations fell below the extreme ranges (Figs 1 and 2) found in age-matched controls. The values found for the various subsets of disease are given in Table 2. Multiple intergroup comparisons of DHEAS concentrations revealed no significant differences apart from higher levels in MSpa than in MUIA (P = 0.04). Even in patients with MSpa, DHEAS concentrations were lower than in male controls (4.61 ± 1.87 vs 6.19 ± 4.12 μmol/l, P < 0.001). This difference remained equally significant after age was controlled for.

Bottom Line: In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls.Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men.We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Rheumatology, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa. Dessein@elink.co.za

ABSTRACT
Hypothalamic-pituitary-adrenal underactivity has been reported in rheumatoid arthritis (RA). This phenomenon has implications with regard to the pathogenesis and treatment of the disease. The present study was designed to evaluate the secretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEAS) and its relation to clinical variables in RA, spondyloarthropathy (Spa), and undifferentiated inflammatory arthritis (UIA). Eighty-seven patients (38 with RA, 29 with Spa, and 20 with UIA) were studied, of whom 54 were women. Only 12 patients (14%) had taken glucocorticoids previously. Age-matched, healthy women (134) and men (149) served as controls. Fasting blood samples were taken for determination of the erythrocyte sedimentation rate (ESR), serum DHEAS and insulin, and plasma glucose. Insulin resistance was estimated by the homeostasis-model assessment (HOMAIR). DHEAS concentrations were significantly decreased in both women and men with inflammatory arthritis (IA) (P < 0.001). In 24 patients (28%), DHEAS levels were below the lower extreme ranges found for controls. Multiple intergroup comparisons revealed similarly decreased concentrations in each disease subset in both women and men. After the ESR, previous glucocorticoid usage, current treatment with nonsteroidal anti-inflammatory drugs, duration of disease and HOMAIR were controlled for, the differences in DHEAS levels between patients and controls were markedly attenuated in women (P = 0.050) and were no longer present in men (P = 0.133). We concluded that low DHEAS concentrations are commonly encountered in IA and, in women, this may not be fully explainable by disease-related parameters. The role of hypoadrenalism in the pathophysiology of IA deserves further elucidation. DHEA replacement may be indicated in many patients with IA, even in those not taking glucocorticoids.

Show MeSH
Related in: MedlinePlus