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MODERN RHEUMATOLOGY Vol.14 No.4
>MR14-4
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| 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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Yasuo Kuroki1 , Chihiro Takabayashi2.3, Katsuhito Nishiyama1, Takao Shimada1, Shunichi Shiozawa2, Kazuo Chihara3 and Yasuyuki Ueba1 |
(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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Received: 17 October 2003 Accepted: 23 April 2004 |
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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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| Key words |
| Adrenocorticotropic hormone (ACTH) response - Depression - Hypothalamic pituitary adrenal (HPA) axis - Low-dose prednisolone - Rheumatoid arthritis (RA) |
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