Cortisol elimination from plasma in premenopausal women with rheumatoid arthritis

Abstract

Objective: To test the hypothesis that cortisol elimination from plasma can contribute to relatively low cortisol in premenopausal women with rheumatoid arthritis (RA). Methods: Twelve premenopausal female patients with RA (39.8 (1.8) years) and nine healthy control women matched for age and body mass index (42 (3.3) years) were enrolled in the study. None of the patients had previously been receiving treatment with glucocorticoids. After dexamethasone suppression (2 mg by mouth) the evening before the study, 20 mg of hydrocortisone was given. Blood and saliva samples were drawn six hours after injection of hydrocortisone. Plasma and salivary cortisol were measured. Results: Dexamethasone administration suppressed plasma cortisol concentrations to an almost undetectable level in all subjects, except one with RA. In this subject, a raised concentration of plasma cortisol was verified by repeated analysis despite the fact that cortisol concentration in the saliva sample measured simultaneously was not raised. No significant difference in the disappearance curve of cortisol in plasma or in salivary cortisol levels was found between the patients with RA and the healthy controls. Conclusions: The profile of disappearance of total cortisol from plasma, and salivary cortisol levels during the elimination phase after its intravenous administration, are unchanged in premenopausal women with RA. Alterations in cortisol clearance are not likely to have a role in cortisol availability in patients with RA.

Use of the Dexamethasone-Corticotrophin Releasing Hormone Test to Assess Hypothalamic-Pituitary-Adrenal Axis Function in Rheumatoid Arthritis

“…Plasma and salivary cortisol have been measured in a study testing cortisol elimination from plasma in premenopausal women with RA, where the elimination profiles were similar, but correlation analysis was not reported [29]. However, some RA patients have hyposalivation and reduced buffering capacity [31–33] and 25–35% of RA patients have secondary Sjogren's syndrome [34, 35], which might alter the relationship between plasma and salivary concentrations.…”

“…Measurement of salivary cortisol is a common method to assess HPA axis activity in RA [ 27 – 30 ] but to our knowledge, this is the first paper that has studied the correlation between salivary and plasma cortisol in RA patients. Plasma and salivary cortisol have been measured in a study testing cortisol elimination from plasma in premenopausal women with RA, where the elimination profiles were similar, but correlation analysis was not reported [ 29 ]. However, some RA patients have hyposalivation and reduced buffering capacity [ 31 – 33 ] and 25–35% of RA patients have secondary Sjogren's syndrome [ 34 , 35 ], which might alter the relationship between plasma and salivary concentrations.…”