Hypothalamic-Pituitary-Adrenal Axis Function in Patients with Rheumatoid Arthritis Treated with Different Glucocorticoid Approaches

Abstract

Glucocorticoids (GCs) continue to be an important treatment option in rheumatoid arthritis (RA) - despite their multitude of side effects. Amongst those, suppression of the hypothalamic-pituitary-adrenal (HPA) axis plays a dominant role. In clinical practice, low-dose GC therapy of 5 mg or less per day seems to be safest in eschewing these undesirable effects and assuring function of the HPA axis. Further research has shown that, apart from dosage, the degree of HPA axis suppression by exogenous GCs is not only dependent on the duration of therapy, but that it also underlies a significant diurnal variation. The recent development of a novel modified-release (MR) prednisone formula reflects an attempt at targeting these circadian neuroendocrine pathways of the HPA axis' function and their interplay with the immune system in RA. Data from a subset of 28 patients included in the CAPRA-1 study indicated that chronotherapy with MR prednisone has no adverse effect on HPA function. Whether adapting GC therapy to a pathophysiological circadian pattern might even be beneficial will have to be further investigated.

Targeting Tumor Necrosis Factor Alpha for Alzheimer’s Disease

“…Interestingly, dexamethasone is commonly co-administered with thalidomide analogs in cancer treatment (see section 5.8 below) because a cumulative effect on inflammation reduction was noted during clinical trials. However, long term administration of corticoids often results in adverse events such as increased risks of infection, osteoporosis, and mental depression via alteration of the hypothalamic-pituitaryadrenal (HPA) axis [168, 169], limiting their potential to treat chronic disorders like AD.…”

Increased Serum Levels of Brain-Derived Neurotrophic Factor Contribute to Inflammatory Responses in Patients with Rheumatoid Arthritis

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Distinguishing the dominant species of pathogen in ethmoidal sinusitis by sequencing DNA dataset analysis

“…Chronic ethmoidal sinusitis is caused by acute ethmoidal sinusitis that cannot be completely cured or recurrent acute ethmoidal sinusitis (19). Chronic sinusitis is often associated with chronic maxillary sinusitis (14). Pathogenic microorganisms penetrate the mucosal barrier to invade blood vessels or bone, which can cause vasculitis, vascular embolization, bone destruction and tissue necrosis (17).…”

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