Gonadal hormones in men with rheumatoid arthritis--from onset through 2 years.
OBJECTIVE
To evaluate changes over a 2-year course in the hypothalamic-pituitary-gonadal (HPG) axis in men with early rheumatoid arthritis (RA) from start of treatment with disease modifying antirheumatic drugs.


METHODS
Forty-one men with early RA and with joint symptoms less than 1 year were studied. Mean age at inclusion was 53 years and mean disease duration 6 months. They were followed prospectively for 2 years for disease activity [Disease Activity Score 28 (DAS28)], physical impairment (Health Assessment Questionnaire), total serum testosterone, non-sex hormone-binding globulin-bound testosterone, and luteinizing hormone (LH). A group of 131 healthy, medicine-free men served as controls for baseline hormone concentrations.


RESULTS
The men with RA already had mean testosterone levels lower than controls early in the disease course. Patients older than 50 years also had significantly lower LH levels compared with controls, consistent with mild hypogonadotropic hypogonadism. In patients who responded to treatment at the 2-year followup the testosterone levels increased significantly. A decrease in DAS28 during the 2 years correlated significantly with increased testosterone levels (r(s) = -0.46, p = 0.006). LH levels were low and stable and did not correlate with disease activity.


CONCLUSIONS
In early RA, current inflammation seemed to affect the HPG axis, mainly at the gonadal rather than the hypothalamic-pituitary level. Prospective studies are indicated to determine if low HPG activity may be a cause rather than a consequence of a chronic inflammatory state.
Tengstrand
Birgitta
B
Department of Rheumatology, Unit of Obstetrics and Gynecology, Division of ClinicalChemistry, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. birgitta.tengstrand@karolinska.se
Carlström
Kjell
K
Hafström
Ingiäld
I
D000328:Adult; D000375:Aging / Q000378:metabolism; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D007006:Hypogonadism / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000378:metabolism* / Q000503:physiopathology; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000378:metabolism* / Q000503:physiopathology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood*
D018501:Antirheumatic Agents; D013739:Testosterone; D007986:Luteinizing Hormone