TY - JOUR T1 - TNFα regulates cortisol metabolism in vivo in patients with inflammatory arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 464 LP - 469 DO - 10.1136/annrheumdis-2013-203926 VL - 74 IS - 2 AU - Dominika E Nanus AU - Andrew D Filer AU - Beverly Hughes AU - Benjamin A Fisher AU - Peter C Taylor AU - Paul M Stewart AU - Christopher D Buckley AU - Iain McInnes AU - Mark S Cooper AU - Karim Raza Y1 - 2015/02/01 UR - http://ard.bmj.com/content/74/2/464.abstract N2 - Objective To determine the relationship between inflammation and glucocorticoid metabolism in vivo, in a clinical study of patients with inflammatory arthritis treated with anti-TNFα therapy. Methods Urine samples were collected from patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) as part of a multicentre study assessing responses to infliximab and etanercept. Systemic measures of glucocorticoid metabolism were assessed by gas chromatography/mass spectrometry at weeks 0 (baseline), 4 and 12 after anti-TNFα therapy. Clinical data including DAS28 and C-reactive protein were also collected. Results Systemic measures of 11β-HSD1 activity in patients with inflammatory arthritis decreased significantly following anti-TNFα therapy in patients with RA and PsA. Additionally, the activity of the glucocorticoid inactivating enzyme 5α-reductase appeared to increase significantly. Conclusions This study demonstrates, for the first time, that the increased 11β-HSD1 activity seen in patients with inflammatory arthritis is mediated through TNFα. Furthermore, the changes in related glucocorticoid metabolising enzymes suggest that there is a coordinated change in glucocorticoid metabolism which promotes higher tissue glucocorticoid levels. ER -