RESEARCH - Increased DHEAS levels in patients with RA after treatment with TNF antagonists

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Journal of Rheumatology

July 2007

Increased DHEAS Levels in Patients with Rheumatoid Arthritis After

Treatment with Tumor Necrosis Factor Antagonists: Evidence for

Improved Adrenal Function

SOFIA ERNESTAM, INGIÄLD HAFSTRÖM, SIGBRITT WERNER, KJELL CARLSTRÖM,

and BIRGITTA TENGSTRAND

ABSTRACT.

Objective. To determine if major reduction of inflammation with

longterm tumor necrosis factor (TNF) antagonist treatment has any

influence on the adrenal and gonadal axes in patients with rheumatoid

arthritis (RA).

Methods. Forty-eight patients with RA were treated with infliximab or

etanercept for 2 years. Disease activity, clinical response, and

physical function were evaluated and serum levels of high sensitivity

C-reactive protein and interleukin 6 were analyzed before start of

treatment and after 1 and 2 years. At the same timepoints

adrenocorticotropic hormone (ACTH), cortisol, and

dehydroepiandrosterone sulfate (DHEAS) were analyzed; luteinizing

hormone (LH), estradiol, and testosterone were analyzed as well in 18

male patients.

Results. DHEAS increased (p < 0.05) after 1 and 2 years of treatment

with TNF antagonists. No change in serum levels of ACTH, cortisol, LH,

estradiol, or testosterone was recorded during the 2 years. The

increased levels of DHEAS correlated with improved physical function

measured by Health Assessment Questionnaire (p < 0.01). There was no

correlation between hormone levels and clinical response or

inflammatory markers. A longitudinal stability in individual hormone

levels was found between baseline and 2 years, most markedly for DHEAS

levels (rs = 0.90, p < 0.01). A female subgroup characterized by low

levels of DHEAS had a lower age at disease onset.

Conclusion. The increased DHEAS levels may indicate an improved

adrenal function during 2 years' treatment with TNF antagonists.

Improved physical function, correlated to increased DHEAS levels, may

be an effect of better adrenal function during powerful

antiinflammatory treatment. The stability in individual hormone levels

suggests a stable hormonal homeostasis, independent of inflammatory

activity. (First Release May 1 2007; J Rheumatol 2007;34:1451-8)

http://www.jrheum.com/subscribers/07/07/1451.html

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