Effects of dehydroepiandrosterone on quality of life in premenopausal women with rheumatoid arthritis: A preliminary randomized clinical trial

Abstract

Aim: Chronic inflammation and subsequent use of glucocorticoids can lead to relative adrenocortical insufficiency in patients with rheumatoid arthritis (RA). Previously, adrenocortical hormone, dehydroepiandrosterone (DHEA) was shown as a potential therapy for autoimmune disorders. However, data regarding effects of DHEA in RA are limited. The aim of this study was to investigate the effects of DHEA on quality of life (QOL) in premenopausal rheumatoid arthritis patients. Method: In this randomized double blinded, controlled trial 46 premenopausal rheumatoid arthritis patients were assigned to receive 50 mg/d DHEA (23 patients) or placebo (23 patients) for 12 weeks. Disease Activity Score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) questionnaire, visual analog score and swollen and tender joint counts (both 0-28) were used for assessment of disease activity. Persianvalidated World Health Organization Quality of Life Brief version (WHOQOL BREF) questionnaire was used to assess quality of life. Results: In comparison to the control group more improvement in QOL (P = .025) and environment health (P = .001) was observed in the DHEA group. After adjustment for age and disease duration DHEA was associated with more improvement in QOL (P = .01), psychological (P = .02) and physical health (P = .03). A trend toward a decrease in ESR was observed in DHEA group (P = .06). DAS was improved in both groups; however, there was no significant change in DAS28 between groups (P = .88). Frequency of adverse events albeit minor was similar in both groups. Conclusion: Our study supports a slightly superior effect of DHEA over placebo to improve QOL in premenopausal female patients with rheumatoid arthritis. We did not find improvement in DAS in the DHEA group over placebo.

Dehydroepiandrosterone (DHEA) Supplementation in Rheumatic Diseases: A Systematic Review

“…The use of supraphysiological doses had led the RA patients to achieve ACR of 20% in 18% of patients, 35 while the other did not differ from placebo. 34 The only study on fibromyalgia failed to show any benefit. 5 ( Table 2 ).…”

“…Some improvement in dryness, fatigue, and quality of life was observed without differences compared to placebo. 29 – 31 Also, the two studies on RA were not reassuring; 34 , 35 both had a small number of patients (one with 11 and the other with 46 patients), and one used a low dose (50 mg/day) while the other used supraphysiological dose (200mg/day) of DHEA. The use of supraphysiological doses had led the RA patients to achieve ACR of 20% in 18% of patients, 35 while the other did not differ from placebo.…”

Dehydroepiandrosterone sulfate indicates decreased sulfation capacity and impaired quality of life in Primary Sclerosing Cholangitis

“…DHEA-S itself has been widely advertised as an over-the-counter supplement that can improve various symptoms related to different conditions, including depression and mood disorders, osteoporosis, adrenal insufficiency, and rheumatoid arthritis [15]. Data in support of these claims remain controversial, with numerous meta-analyses producing inconclusive results [23][24][25][26]. Supplementation with DHEA had a positive effect on the HRQoL in small groups of patients with systemic lupus erythematosus and hypopituitarism [27,28].…”

What is the impact of sex hormones on the pathogenesis of rheumatoid arthritis?

“…Meanwhile, two trials of dehydroepiandrosterone (DHEA) have been published. A small open-label trial of DHEA treatment in elderly RA patients (six post-menopausal female and five male) found no benefit on disease activity (98), while a randomized placebo-controlled trial of DHEA in pre-menopausal RA patients (n = 46) found improvements in quality of life but not disease activity scores (99).…”