Article Text
Abstract
Objective: To study in parallel the outflow of the sympathetic nervous system (SNS) and the hypothalamic-pituitary adrenal (HPA) axis tone in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
Methods: 32 patients with SLE, 62 with RA, and 65 healthy subjects (HS) were included. To measure the tone of the HPA axis, plasma ACTH and serum cortisol were determined. Serum neuropeptide Y (NPY) was used to evaluate the sympathetic outflow.
Results: Patients with SLE had increased NPY levels in comparison with HS, irrespective of prior prednisolone treatment (p<0.001). For patients with RA, only those with prednisolone treatment had increased NPY levels in comparison with HS (p = 0.016). Daily prednisolone dose correlated positively with serum NPY in RA (RRank = 0.356, p = 0.039). In contrast, plasma ACTH levels were generally decreased significantly in comparison with HS in SLE with prednisolone, and in RA with/without prednisolone. Similarly, serum cortisol levels were also decreased in SLE with/without prednisolone, and in RA with prednisolone. The NPY/ACTH ratio was increased in SLE and RA, irrespective of prior prednisolone treatment. The NPY/cortisol ratio was increased in SLE with/without prednisolone, and in RA with prednisolone. Twelve weeks’ anti-TNF antibody treatment with adalimumab did not decrease NPY levels in RA, irrespective of prednisolone treatment.
Conclusions: An increased outflow of the SNS was shown and a decreased tone of the HPA axis in patients with SLE and RA. Low levels of cortisol in relation to SNS neurotransmitters may be proinflammatory because cooperative anti-inflammatory coupling of the two endogenous response axes is missing.
- ACR, American College of Rheumatology
- ACTH, adrenocorticotropic hormone
- CRH, corticotropin-releasing hormone
- HPA, hypothalamic-pituitary-adrenal
- HS, healthy subjects
- IL, interleukin
- NPY, neuropeptide Y
- RA, rheumatoid arthritis
- SLE, systemic lupus erythematosus
- SLEDAI, SLE Disease Activity Index
- SNS, sympathetic nervous system
- TNF, tumour necrosis factor
- adrenal hormones
- neuropeptide Y
- rheumatoid arthritis
- sympathetic nervous system hormones
- systemic lupus erythematosus
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- ACR, American College of Rheumatology
- ACTH, adrenocorticotropic hormone
- CRH, corticotropin-releasing hormone
- HPA, hypothalamic-pituitary-adrenal
- HS, healthy subjects
- IL, interleukin
- NPY, neuropeptide Y
- RA, rheumatoid arthritis
- SLE, systemic lupus erythematosus
- SLEDAI, SLE Disease Activity Index
- SNS, sympathetic nervous system
- TNF, tumour necrosis factor