Adrenocorticotropic hormone response to hypoglycemic stress was preserved by a single bedtime 3-mg dose of prednisolone in patients with rheumatoid arthritis |
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Authors: | Email author" target="_blank">Yasuo?KurokiEmail author Chihiro?Takabayashi Katsuhito?Nishiyama Takao?Shimada Shunichi?Shiozawa Kazuo?Chihara Yasuyuki?Ueba |
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Institution: | (1) Department of Internal Medicine, Kanebo Memorial Hospital, 1-9-1 Misaki-cho, Hyogo-ku, Kobe 652-0855, Japan;(2) Department of Rheumatology, Kobe University FHS School of Medicine, Kobe, Japan;(3) Department of Endocrinology, Kobe University School of Medicine, Kobe, Japan |
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Abstract: | We have studied the effect of low-dose prednisolone administered before sleep on the hypothalamic–pituitary–adrenal axis and
the symptoms of patients with rheumatoid arthritis (RA). Plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels
were measured in the basal state and after hypoglycemic stress induced by the insulin tolerance test in 21 patients receiving
prednisolone at 3–5 mg daily. The patient's global assessment of their disease activity scores on a 100-mm visual analogue
scale (VAS) and self-reporting of their functional status using the health assessment questionnaire (HAQ) were evaluated.
While both the cortisol and the ACTH responses were impaired dose-dependently in patients treated with prednisolone, the ACTH
response was maintained in patients treated with a single daily 3-mg dose of prednisolone before sleep. There was an inverse
correlation between the extent of the ACTH response and disease activity as revealed by the VAS (r = 0.521, P < 0.05). There was also a weak correlation between VAS and the self-rating depression scale (SDS) (r = 0.443), especially when only patients with an HAQ score > 10 were included in order to exclude any possible contribution
of the limitations in the activities of daily living to the SDS score (r = 0.859, P < 0.05). These results suggest that a single daily low dose (3 mg) of prednisolone administered before sleep maintains the
ACTH response in RA patients, and patients with a good ACTH response appear to be less depressed and have milder symptoms. |
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Keywords: | Adrenocorticotropic hormone (ACTH) response Depression Hypothalamic– pituitary– adrenal (HPA) axis Low-dose prednisolone Rheumatoid arthritis (RA) |
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