Atzeni F, Sarzi-Puttini P, DePortu S, Cutolo M, Carrabba M, Straub R H
Laboratory of Exp. Rheumatology and Neuroendocrino-Immunology, Department of Internal Medicine I, University Hospital Regensburg, Germany.
Clin Exp Rheumatol. 2008 Jan-Feb;26(1):103-8.
In patients with rheumatoid arthritis (RA), long-term therapy with anti-tumor necrosis factor (TNF) antibodies sensitizes the pituitary gland and improves adrenal androgen secretion in prednisolone-naïve patients. However, whether this is similar in psoriatic arthritis (PsA) is not known. The aim of this study was to assess the effect of 12 weeks of etanercept treatment upon the function of the HPA axis in patients with PsA.
Eleven prednisolone-naïve patients (mean age 47.3+/-8.9 years) with PsA were included. We measured serum levels of adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone (17OHP), cortisol, and androstenedione (ASD), at baseline and at 4 and 12 weeks after initiation of anti-TNF therapy (etanercept, 50 mg every week as a single dose by sc. injection). Clinical improvement was assessed using the Disease Activity Score-28 (DAS-28).
Mean levels of serum ACTH, serum cortisol, serum 17OHP and serum ASD did not markedly change during 12 weeks of etanercept treatment. Similarly, the ratio of serum cortisol divided by serum ACTH did not change during 12 weeks of anti-TNF treatment. However, an increase of serum cortisol relative to serum 17OHP or ASD was related to clinical improvement. This indicates that improvement was linked to higher serum cortisol levels relative to others adrenal hormones.
This is the first study to demonstrate baseline serum levels and the course of HPA axis-related hormones in patients with PsA. An increase of serum cortisol relative to others adrenocortical hormones (i.e., androstenedione and ACTH) was accompanied by clinical improvement.
在类风湿关节炎（RA）患者中，使用抗肿瘤坏死因子（TNF）抗体进行长期治疗可使垂体敏感，并改善未使用过泼尼松龙的患者的肾上腺雄激素分泌。然而，银屑病关节炎（PsA）患者是否也如此尚不清楚。本研究的目的是评估依那西普治疗12周对PsA患者下丘脑-垂体-肾上腺（HPA）轴功能的影响。
纳入11例未使用过泼尼松龙的PsA患者（平均年龄47.3±8.9岁）。在基线以及开始抗TNF治疗（依那西普，每周50mg皮下注射单剂量）后4周和12周时，我们测量了血清促肾上腺皮质激素（ACTH）、17-羟孕酮（17OHP）、皮质醇和雄烯二酮（ASD）水平。使用疾病活动评分-28（DAS-28）评估临床改善情况。
在依那西普治疗的12周内，血清ACTH、血清皮质醇、血清17OHP和血清ASD的平均水平没有明显变化。同样，在抗TNF治疗的12周内，血清皮质醇除以血清ACTH的比值也没有变化。然而，血清皮质醇相对于血清17OHP或ASD的增加与临床改善有关。这表明改善与相对于其他肾上腺激素的较高血清皮质醇水平有关。
这是第一项证明PsA患者基线血清水平和HPA轴相关激素变化过程的研究。血清皮质醇相对于其他肾上腺皮质激素（即雄烯二酮和ACTH）的增加伴随着临床改善。
