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Hypothalamic–pituitary–adrenal axis stress test in patients with early RA: role of corticotropin-releasing hormone promoter polymorphisms
  1. O Malysheva1,
  2. U Wagner1,
  3. M Wahle2,
  4. M Pierer1,
  5. U Wagner1,
  6. G K Stalla3,
  7. C G O Baerwald1
  1. 1Rheumatology Unit, Department of Medicine, University Hospital, Leipzig, Germany
  2. 2Medical Clinic II, Rheumatology, Johann W Goethe-University Hospital, Frankfurt, Germany
  3. 3Neuroendocrinology Unit, Max Plank Institute of Psychiatry, München, Germany
  1. Correspondence to Dr O Malysheva, Rheumatology Unit, Department of Medicine, University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany; olga.malysheva{at}medizin.uni-leipzig.de

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Growing evidence supports the hypothesis that alterations of the stress response and interactions between the neuroendocrine and immune systems contribute to the pathogenesis of rheumatoid arthritis (RA).1,,4 Central to the maintenance of homeostasis is an appropriate response of the hypothalamic–pituitary–adrenal (HPA) axis as well as the sympathetic nervous system.3 5 Corticotropin-releasing hormone (CRH) is the strongest known activator of the HPA axis, which has been functionally implicated in the regulation of many endocrine functions such as glucocorticoid release from the adrenal gland and associated endocrine-immune responses.6 Recently, we described several polymorphisms, named A1B1, A2B1 and A2B2, in the highly conserved regulatory region of the CRH gene, which modulated gene transcription in vitro.7 To further evaluate the impact of CRH promoter polymorphisms in vivo, the activity of the HPA axis in patients with early RA was studied by measuring hormone levels during an insulin hypoglycaemia test (IHT), a standardised form …

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