Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study
Objectives A reduced adrenal reserve-associated cortisol production relative to the enhanced needs of chronic inflammation (disproportion principle) has been observed in rheumatoid arthritis (RA). We examined the possible clinical value of diurnal cortisol measurements in active RA on treatment resp...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-02-01
|
| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/10/1/e003575.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849720775964098560 |
|---|---|
| author | George E Fragoulis Antonis Fanouriakis Maria G Tektonidou Petros P Sfikakis Gerasimos Evangelatos Vasiliki-Kalliopi Bournia Katerina Laskari Stylianos Panopoulos GEORGE P CHROUSOS Maria P Yavropoulou Maria G Filippa Nikolaos I Vlachogiannis Aimilia Mantzou Aggeliki Papapanagiotou |
| author_facet | George E Fragoulis Antonis Fanouriakis Maria G Tektonidou Petros P Sfikakis Gerasimos Evangelatos Vasiliki-Kalliopi Bournia Katerina Laskari Stylianos Panopoulos GEORGE P CHROUSOS Maria P Yavropoulou Maria G Filippa Nikolaos I Vlachogiannis Aimilia Mantzou Aggeliki Papapanagiotou |
| author_sort | George E Fragoulis |
| collection | DOAJ |
| description | Objectives A reduced adrenal reserve-associated cortisol production relative to the enhanced needs of chronic inflammation (disproportion principle) has been observed in rheumatoid arthritis (RA). We examined the possible clinical value of diurnal cortisol measurements in active RA on treatment response prediction.Methods Diurnal cortisol production (measured at: 08–12:00/18:00–22:00) was assessed by electrochemiluminescence immunoassay in 28 consecutive patients with moderately/highly active RA, as well as 3 and 6 months after treatment initiation or/escalation. Twenty-eight COVID-19 patients and 28 age-matched healthy individuals (HC) served as controls.Results Saliva diurnal cortisol production in patients with RA was similar to that of HC, despite 12-fold higher serum C reactive protein (CRP) levels, and lower than COVID-19 patients (area under the curve: RA: 87.0±37.6 vs COVID-19: 146.7±14.3, p<0.001), having similarly high CRP. Moreover, a disturbed circadian cortisol rhythm at baseline was evident in 15 of 28 of patients with RA vs 4 of 28 and 20 of 28 of HC and COVID-19 patients, respectively. Treatment-induced minimal disease activity (MDA) at 6 months was achieved by 16 of 28 patients. Despite comparable demographics and clinical characteristics at baseline, non-MDA patients had lower baseline morning cortisol and higher adrenocorticotropic hormone (ACTH) levels compared with patients on MDA (cortisol: 10.9±4.0 vs 18.4±8.2 nmol/L, respectively, p=0.005 and ACTH: 4.8±3.3 vs 2.4±0.4 pmol/L, respectively, p=0.047). Baseline morning cortisol <13.9 nmol/L predicted non-MDA at 6 months (75% sensitivity, 92% specificity, p=0.006). Prospective measurements revealed that individualised diurnal cortisol production remained largely unchanged from baseline to 3 and 6 months.Conclusions An impaired adrenal reserve is present in patients with RA. Further studies to confirm that assessment of diurnal cortisol production may be useful in guiding treatment decisions and/or predicting treatment response in RA are warranted.Trial registration number NCT05671627. |
| format | Article |
| id | doaj-art-9f6ca0af305643c684f18bdefca7ec67 |
| institution | DOAJ |
| issn | 2056-5933 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-9f6ca0af305643c684f18bdefca7ec672025-08-20T03:11:52ZengBMJ Publishing GroupRMD Open2056-59332024-02-0110110.1136/rmdopen-2023-003575Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort studyGeorge E Fragoulis0Antonis Fanouriakis1Maria G Tektonidou2Petros P Sfikakis3Gerasimos Evangelatos4Vasiliki-Kalliopi Bournia5Katerina Laskari6Stylianos Panopoulos7GEORGE P CHROUSOS8Maria P Yavropoulou9Maria G Filippa10Nikolaos I Vlachogiannis11Aimilia Mantzou12Aggeliki Papapanagiotou13Institute of Infection, Immunity and Inflammation, University of Glasgow School of Medicine, Glasgow, UKth Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece1 First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, GreeceNational and Kapodistrian University of Athens, School of Medicine, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece21 Rheumatology Unit, 1st Dept. of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens Medical School, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, GreeceUniversity Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine, Endocrinology Unit, National and Kapodistrian University of Athens, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine, Endocrinology Unit, National and Kapodistrian University of Athens, Athens, GreeceFirst Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, GreeceUniversity Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, GreeceDepartment of Biological Chemistry, National and Kapodistrian University of Athens, Athens, GreeceObjectives A reduced adrenal reserve-associated cortisol production relative to the enhanced needs of chronic inflammation (disproportion principle) has been observed in rheumatoid arthritis (RA). We examined the possible clinical value of diurnal cortisol measurements in active RA on treatment response prediction.Methods Diurnal cortisol production (measured at: 08–12:00/18:00–22:00) was assessed by electrochemiluminescence immunoassay in 28 consecutive patients with moderately/highly active RA, as well as 3 and 6 months after treatment initiation or/escalation. Twenty-eight COVID-19 patients and 28 age-matched healthy individuals (HC) served as controls.Results Saliva diurnal cortisol production in patients with RA was similar to that of HC, despite 12-fold higher serum C reactive protein (CRP) levels, and lower than COVID-19 patients (area under the curve: RA: 87.0±37.6 vs COVID-19: 146.7±14.3, p<0.001), having similarly high CRP. Moreover, a disturbed circadian cortisol rhythm at baseline was evident in 15 of 28 of patients with RA vs 4 of 28 and 20 of 28 of HC and COVID-19 patients, respectively. Treatment-induced minimal disease activity (MDA) at 6 months was achieved by 16 of 28 patients. Despite comparable demographics and clinical characteristics at baseline, non-MDA patients had lower baseline morning cortisol and higher adrenocorticotropic hormone (ACTH) levels compared with patients on MDA (cortisol: 10.9±4.0 vs 18.4±8.2 nmol/L, respectively, p=0.005 and ACTH: 4.8±3.3 vs 2.4±0.4 pmol/L, respectively, p=0.047). Baseline morning cortisol <13.9 nmol/L predicted non-MDA at 6 months (75% sensitivity, 92% specificity, p=0.006). Prospective measurements revealed that individualised diurnal cortisol production remained largely unchanged from baseline to 3 and 6 months.Conclusions An impaired adrenal reserve is present in patients with RA. Further studies to confirm that assessment of diurnal cortisol production may be useful in guiding treatment decisions and/or predicting treatment response in RA are warranted.Trial registration number NCT05671627.https://rmdopen.bmj.com/content/10/1/e003575.full |
| spellingShingle | George E Fragoulis Antonis Fanouriakis Maria G Tektonidou Petros P Sfikakis Gerasimos Evangelatos Vasiliki-Kalliopi Bournia Katerina Laskari Stylianos Panopoulos GEORGE P CHROUSOS Maria P Yavropoulou Maria G Filippa Nikolaos I Vlachogiannis Aimilia Mantzou Aggeliki Papapanagiotou Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study RMD Open |
| title | Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study |
| title_full | Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study |
| title_fullStr | Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study |
| title_full_unstemmed | Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study |
| title_short | Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study |
| title_sort | diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis a 6 month real life prospective cohort study |
| url | https://rmdopen.bmj.com/content/10/1/e003575.full |
| work_keys_str_mv | AT georgeefragoulis diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT antonisfanouriakis diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT mariagtektonidou diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT petrospsfikakis diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT gerasimosevangelatos diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT vasilikikalliopibournia diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT katerinalaskari diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT stylianospanopoulos diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT georgepchrousos diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT mariapyavropoulou diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT mariagfilippa diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT nikolaosivlachogiannis diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT aimiliamantzou diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy AT aggelikipapapanagiotou diurnalproductionofcortisolandpredictionoftreatmentresponseinrheumatoidarthritisa6monthreallifeprospectivecohortstudy |