Epinephrine Infusion Lowers Serum Cortisol in Patients With Rheumatoid Arthritis

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Epinephrine Infusion Lowers Serum Cortisol in Patients With Rheumatoid

Arthritis

NEW YORK (Reuters Health) Aug 28 - Patients with rheumatoid arthritis

show a dip in serum cortisol and in 17-hydroxyprogesterone (17OHP) after

an infusion of intravenous epinephrine, whereas healthy controls show no

such change, European researchers report in the August issue of The

Journal of Rheumatology.

To further elucidate the effect of stress on rheumatoid arthritis, Dr.

Rainer H. Straub of University Medical Center Regensburg, Germany, and

colleagues infused 15 untreated female patients with rheumatoid

arthritis (mean age 51) and 7 healthy female controls (mean age 48) with

epinephrine 0.05 micrograms/kg per minute for 20 minutes.

The investigators found that baseline serum cortisol and 17OHP levels

were higher in controls both before and after epinephrine infusion.

After epinephrine infusion, patients with RA showed a statistically

significant decrease in serum cortisol levels and serum 17OHP.

Adrenocorticotropic hormone levels (ACTH) and dehydroepiandrosterone

sulfate (DHEAS) levels tended to drop in RA patients, though not to a

statistically significant degree, but remained constant in controls.

Since patients with RA or juvenile chronic arthritis may have elevated

levels of catecholamines or an increased sympathetic tone, " adrenoceptor

expression may be changed in tissue, " the researchers explain. " Indeed,

it has been demonstrated that beta-adrenoceptor expression on peripheral

blood mononuclear cells was decreased, " they write. " This could lead to

subsequent impairment of epinephrine effects due to receptor

desensitization. "

While the mechanisms for such changes in the sympathetic nervous system

of RA patients remains unknown, " some situations may arise in which

psychological stress with similar conditions comparable to epinephrine

infusion may lead to an unfavorable response of the

hypothalamic-pituitary-adrenal axis, " the investigators point out.

" Downregulation of serum cortisol in such a situation may be a relevant

factor for exacerbation of RA. "

J Rheumatol 2002;29:1659-1664.