ABNORMAL LEVELS OF SEX HORMONES IN MEN WITH RHEUMATOID ARTHRITIS: HIGH CORRELATION BETWEEN SERUM ESTRADIOL AND CURRENT DEGREE OF INFLAMMATION

B. Tengstrand , K. Carlström , L. Felländer-Tsai , I. Hafström Dep. of Rheumatology, Dep. of obstetrics and gynaecologi, Dep. of ortophaedic surgery, Dep. of rheumatology, Huddinge University Hospital, Stockholm, SwedenObjectives: Men with rheumatoid arthritis (RA) have low testosterone levels but not much is known about other sex hormones. The aim of this study was to investigate the serum levels of dehydroepiandrosterone sulfate (DHEAS), estradiol and estrone in men with RA and to evaluate the impact of various disease variables on these sex hormones.Methods: Inflammatory activity, measured as disease activity score including 28 joints (DAS28), and degree of disability, measured with Health Assessment Questionnaire (HAQ), were estimated in 101 men with RA. Presence of erosions, rheumatoid factor (RF) as well as smoking habits and body mass index (BMI) were recorded. DHEAS, measured only in patients not taking glucocorticoids, estradiol and estrone were measured in patients and in healthy controls.Results: DHEAS and estrone were lower (p<0.05 and p<0.001 respectively) and estradiol was higher (p<0.0001) in patients compared with healthy controls. DHEAS showed a weak negative correlation with CRP (p<0.05) and was higher in RF negative patients (p<0.05). Estrone did not correlate with any disease variable, whereas estradiol correlated strongly and positively with all measured indices of inflammation e.g. the correlation between ESR and estradiol was R= 0.49 (p<0.0001).Conclusion: Men with RA had aberrations in all sex hormones analysed although only estradiol consistently correlated with inflammation. Proinflammatory cytokines, TNFalfa, IL-1 and IL-6 increase aromatase activity, which enhances the conversion of androgens to estrogens. This may explain the low gonadal androgens in men with RA reported in several previous studies and the high estradiol levels found in this study. The low estrone and DHEAS levels may depend on a shift in the adrenal steroidogenesis towards the glucocorticoid pathway due to the same proinflammatory cytokines.Citation: , volume , supplement , year 2003, page Session: Rheumatoid arthritis – Clinical aspects