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Sex Hormone Concentrations in Patients with Rheumatoid
Arthritis Are Not Normalized During
12 Weeks of Anti-Tumor Necrosis Factor Therapy
RAINER H. STRAUB, PETER HÄRLE, FABIOLA ATZENI, CLAUDIA WEIDLER, MAURIZIO CUTOLO, and PIERCARLO SARZI-PUTTINI ABSTRACT. Objective. Androgens such as dehydroepiandrosterone sulfate (DHEAS) and testosterone are markedly lower in postmenopausal women with rheumatoid arthritis (RA) than in controls. In contrast, compared to controls, serum levels of estrogens are normal or elevated in women with RA. Since tumor necrosis factor (TNF) alters production of these hormones, we investigated changes of these hormones during anti-TNF antibody (anti-TNF) therapy with adalimumab in longstanding RA. Methods. In this longitudinal anti-TNF therapy study in 13 patients with long-standing RA without prior prednisolone (7 infusions of anti-TNF: Week 0, 2, 4, 6, 8, 10, and 12), we measured serum concentrations of interleukin 6 (IL-6), androstenedione, DHEA, DHEAS, free testosterone, estrone, and 17ß-estradiol. Levels of these hormones in patients were compared to serum levels of 31 age and sex matched healthy controls. Results. Upon treatment with anti-TNF, there was an impressive decrease of clinical markers of inflammation, erythrocyte sedimentation rate, and serum levels of IL-6. Serum levels of DHEAS and free testosterone were markedly lower at baseline in patients compared to controls, but this did not change during anti-TNF therapy. Serum levels of DHEA and 17ß-estradiol were significantly elevated in patients compared to controls, but similarly, anti-TNF therapy did not change initially increased levels. Molar ratios of hormones, which reflect hormone shifts via converting enzymes, showed typical alterations at baseline, but did not change markedly during anti-TNF therapy. Conclusion. Longterm therapy with anti-TNF did not change altered serum levels of typical sex hormones in patients with RA, although baseline values were largely different. In patients with RA, this indicates that alterations of sex hormones and altered activity of respective converting enzymes are imprinted for a long-lasting period over at least 12 weeks. (J Rheumatol 2005;32:1253–7) Key Indexing Terms: RHEUMATOID ARTHRITIS From the Department of Internal Medicine I, Laboratory of Neuroendocrinoimmunology, University Medical Center, Regensburg, Germany; Rheumatology Unit, University Hospital L. Sacco, Milan, Italy; and Division of Rheumatology, Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy. R.H. Straub and C. Weidler are supported by a grant from the Deutsche Forschungsgemeinschaft (DFG Str 511/10-1). P. Sarzi-Puttini and F. Atenzi were supported by Abbott SpA, Campoverde, Italy. R.H. Straub, MD, Professor, Rheumatologist; P. Härle, MD, Rheumatology Fellow; C. Weidler, PhD Student, Department of Internal Medicine I, University Medical Center Regensburg; F. Atenzi, MD, Rheumatology Fellow; P. Sarzi-Puttini, MD, Professor, Rheumatologist, Rheumatology Unit, University Hospital L. Sacco; M. Cutolo, MD, Professor, Rheumatologist, Division of Rheumatology, Department of Internal Medicine and Medical Specialties, University of Genova. Address reprint requests to Dr. R.H. Straub, Department of Internal Medicine I, University Medical Center, D-93042 Regensburg, Germany. E-mail: rainer.straub@klinik.uni-regensburg.de Accepted for publication March 1, 2005. |