title: Increase of sympathetic outflow measured by neuropeptide Y and decrease of the hypothalamic-pituitary-adrenal axis tone in patients with systemic lupus erythematosus and rheumatoid arthritis: another example of uncoupling of response systems.
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 (R(Rank) = 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.
authors.affiliation: Laboratory of Neuroendocrinoimmunology, Department of Internal Medicine I, University Hospital Regensburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Härle
authors.forename: R H
authors.initials: RH
authors.lastname: Straub
authors.forename: R
authors.initials: R
authors.lastname: Wiest
authors.forename: A
authors.initials: A
authors.lastname: Mayer
authors.forename: J
authors.initials: J
authors.lastname: Schölmerich
authors.forename: F
authors.initials: F
authors.lastname: Atzeni
authors.forename: M
authors.initials: M
authors.lastname: Carrabba
authors.forename: M
authors.initials: M
authors.lastname: Cutolo
authors.forename: P
authors.initials: P
authors.lastname: Sarzi-Puttini
mesh_terms: D000068879:Adalimumab; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009478:Neuropeptide Y / Q000097:blood*; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology*; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D009478:Neuropeptide Y; D014409:Tumor Necrosis Factor-alpha; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D000068879:Adalimumab; D006854:Hydrocortisone