Hypothalamic-Pituitary-Gonadal Axis Hormones and Male Rheumatoid Arthritis: Novel Perspectives

Masi, Alfonse T.; Chatterton, Robert T.; Aldag, Jean C.

doi:10.3899/jrheum.090092

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…We observed mean age of onset of RA in the study population is 38.5 years, in whom mean age of onset in male cases were 41 years and in female cases were 37 years, which is consistent with most of the studies 16,17 . Analysis of clinical and laboratory variables between male and female cases showed no significant difference except hemoglobin % and platelet count.…”

Section: Discussionsupporting

confidence: 76%

Does Clinical and Laboratory Markers are Predictive of Radiological Joint Damage in Rheumatoid Arthritis?

et al. 2015

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Section: Discussionsupporting

confidence: 76%

Does Clinical and Laboratory Markers are Predictive of Radiological Joint Damage in Rheumatoid Arthritis?

et al. 2015

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“…Contrary to this, there is one study which reports that depression is not more common in rheumatoid arthritis clinics than in other clinics (Hawley DJ, Wolffe et al). 9 It differs from the study by Van Dyke MM et al, 10 which the prevalence of depression was found much lower than reported by Chris Dickens et al 2003 11 (39.5%) and Frank RG et al (42%). This was however found closer to another study, which reported 23% depression in patients with rheumatoid arthritis.…”

Section: Discussioncontrasting

confidence: 59%

A Study of Pain and Depression in Patients With Rheumatoid Arthritis

Kuttiyil¹,

Raju²

2018

jemds

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BACKGROUNDRheumatoid arthritis is a psychosomatic illness, in which psychological factors play a major role in disease process. Comorbid depression and physical pain are major contributing factors (Chandarna et al, 1 Covic et al), 2 but they are unevaluated and under detected (Brend Lowe et al). 3 Aims and Objectives-To study the prevalence of depression and its association with pain symptoms in rheumatoid arthritis patients. MATERIALS AND METHODSInclusion Criteria-Patients above 18 years with rheumatoid arthritis and without having acute severe physical problems, mental retardation, delirium or dementia. Study Tools-ICD-10 DCR, Brief pain inventory, MADRS. RESULTSOut of the 100 patients, 86% are females and 66% belong to 30 -50 age group and most of them are using steroids (74%) and are having less than 10 years duration of illness (93%). Severe pain intensity score (BPI 10 -20) is present in 30%, pain interference score is more than 20 in 46% of patients and the percentage of pain reduction with medication is only less than 30% in 38% of study population. Depression is present in 22% and the mean MADRS score is 32. BPI pain intensity score (p value .0008), pain interference score (p value .000) and pain reduction score (p value .0003) are significantly related to depression. Intensity of depression assessed by MADRS is significantly correlated with above variables. CONCLUSIONDepression is a common comorbidity in rheumatoid arthritis patients and the level of pain, interference of pain in daily life and reduction of pain with medication is significantly related to depression. The severity of depression is significantly correlated with the above variables.

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“…22 Fatigue and depression are common manifestations of this and may relate to the lower cortisol levels recorded in RA, especially in early disease. [23][24][25] Indeed, the changes in the response of the HPA are documented as also occurring early in RA.…”

Section: Introductionmentioning

confidence: 98%

Hypoadrenalism in patients with fatigue and rheumatic disease

Methiniti¹,

Hamilton²,

Saravanan³

et al. 2010

Rheumatol Rep

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Many patients with rheumatic disease complain of fatigue. Clinicians may interpret this as part of the disease process in the absence of anaemia or hypothyroidism, and sometimes respond with the empiric addition of steroids to therapy. The possibility of true hypoadrenalism is only occasionally considered, and little data exists on the frequency with which it coexists with rheumatic disease. Random serum cortisol may be requested by clinicians to help exclude hypoadrenalism as a factor in fatigue. We undertook a survey to assess how frequently this test was of clinical relevance, what was done in patients with low results, and which patients were most likely to have true adrenal failure. All random cortisol assays requested by the members of a rheumatological team over one year were identified and the notes examined retrospectively. The indication for the request, the result, the ultimate clinical diagnosis and all prior diagnoses were recorded. Where further investigations were undertaken, these too were noted. The results were compared to those in an age and gender matched population of patients with general medical conditions (excluding endocrine disorders) for whom cortisol assays had also been requested. Random cortisol was requested by a team of four consultants in 74 patients with a variety of rheumatic disorders over 12 months, usually because of unexplained fatigue. Among the control group of 75 medical patients, the commonest reasons for requesting cortisol assay were fatigue, low sodium and unexplained anaemia. Mean cortisol levels were significantly higher in medical patients (512 nmol/L) than those with rheumatic disease (351 nmol/L) [P=0.04]. The results were low (<200 nmol/L) in 14 rheumatic patients and 7 medical patients. Among these 21 individuals, synacthen tests were performed in 16 and were indicative of hypoadrenalism in 6 cases. Further investigations revealed primary hypoadrenalism in 3 patients, with tertiary adrenal suppression from oral steroids in three others. All six of these patients had underlying rheumatic disorders, usually RA (3) or systemic lupus erythematosus (SLE) (2). None of the medical patients had an abnormal synacthen test. Fatigue in patients with rheumatic disease may be a presenting feature of hypoadrenalism. Although adrenal failure is rare in medical patients with anaemia, hyponatraemia or fatigue, patients with rheumatic disease and unexplained fatigue merit a random cortisol. If this is low, synacthen testing may be appropriate. Steroids should not be commenced empirically in such patients until hypoadrenalism has been excluded, as a significant minority will have genuine primary adrenal failure, usually due to autoimmune disease

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Hypothalamic-Pituitary-Gonadal Axis Hormones and Male Rheumatoid Arthritis: Novel Perspectives

Cited by 7 publications

References 20 publications

Does Clinical and Laboratory Markers are Predictive of Radiological Joint Damage in Rheumatoid Arthritis?

Does Clinical and Laboratory Markers are Predictive of Radiological Joint Damage in Rheumatoid Arthritis?

A Study of Pain and Depression in Patients With Rheumatoid Arthritis

Hypoadrenalism in patients with fatigue and rheumatic disease

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