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Introduction: Cortisol levels in patients with rheumatoid arthritis (RA) are considered inadequate to ongoing inflammation. One possible mechanism ofthe relative cortisol deficit can be decreased 11beta-hydroxysteroid dehydrogenase type 1 (11BHSD1) activity, an enzyme that converts inactive cortisone to active cortisol. The aim of the study was to determine systemic and local activity of 11 BHSD1 in female patients with RA., Methods: Six female RA patients without glucocorticoid therapy (age 29 +/- 2 years, BMI 21 +/- 1 kg/m2) and six healthy women (age 30 +/- 2 years, BMI 21 +/- 1 kg/m2) were studied. Endogenous cortisol production was suppressed by dexamethasone. 11BHSD1 activity was evaluated by changes in concentrations of total plasma, free plasma, salivary and cortisol in subcutaneous adipose tissue after cortisone acetate administration (25 mg per os)., Results: Concentrations of total plasma, free plasma, salivary, and tissue cortisol increased significantly, however there was no significant difference between RA patients and controls., Conclusion: The result suggests comparable systemic and adipose tissue conversion of cortisone to cortisol. Despite chronic inflammation, systemic activity of 11BHSD1 is not responsible for relative adrenal deficiency in RA. Changes in local activity of the enzyme in tissues affected by inflammatory process cannot be excluded.

The controlled data accumulated so far support only subtle alterations in hypothalamic-pituitary-adrenal (HPA) axis function in rheumatoid arthritis (RA), mainly at the adrenal level, and particularly in a subset of premenopausal onset women. Consequences of the subtle HPA alterations in RA for the disease development remain unclear. From a broader perspective, the unresponsiveness of the HPA axis to chronic inflammation in RA can be simply considered an ongoing adaptation to chronic disease.

Risk of cardiovascular diseases is significantly higher in patients with rheumatoid arthritis (RA) than in normal population, leading to higher mortality of these patients. An accelerated atherosclerosis has been considered a basis for the increased cardiovascular risk in RA. Besides classical atherosclerosis risk factors, systemic inflammation plays a substantial role. Indirect mechanisms such as insulin resistance and dyslipidemia may play a role, however, inflammation probably causes direct damage to blood vessels. Thus, systemic inflammation has a primary role and other factors accelerate this process. An adequate anti-inflammatory therapy can have a positive effect also on cardiovascular diseases in RA.

Background: Dysfunction of endocrine system is very likely one of the important risk factors involved in the pathogenesis of rheumatoid arthritis. The aim of the present study was to investigate the levels of selected hormones in plasma and in synovial fluid of knee joint of patients with rheumatoid arthritis or with osteoarthritis, which could affect the inflammatory processes., Methods and Results: Thirty nine patients with rheumatoid arthritis (22 females and 17 males) and 12 patients with osteoarthritis (6 females and 6 males) were investigated. Concentrations of the following hormones were determined in plasma and synovial fluids: cortisol, 17-beta-estradiol, progesterone, dehydroepiandrosterone, aldosterone, testosterone, prolactin, insulin and C-peptide by using radioimmunoassay kits. Increased levels of 17-beta-estradiol and insulin were found in patients with rheumatoid arthritis as compared to those with osteoarthritis. The plasma concentrations of other hormones under study were not significantly different in these groups of patients. Higher levels of 17-beta estradiol, progesterone and aldosterone were noted in inflammatory knee exudate of patients with rheumatoid arthritis. The levels of other hormones in exudates of patients with rheumatoid arthritis and those with osteoarthritis were not significantly different. The ratio of 17-beta estradiol / cortisol, 17-beta estradiol / testosterone and 17-beta estradiol / dehydroepiandrosterone showed increased proportions of estrogens over androgens or glucocorticoids in exudate from patients with rheumatoid arthritis., Conclusions: These results demonstrated that steroid and peptide hormones are transferred to synovial fluid of knee. The presence of insulin, C-peptide and aldosterone was described for the first time in synovial fluid. In patients with rheumatoid arthritis a predomination of the levels of proinflammatory estrogens over androgens was found in knee exudate. Also the levels of aldosterone and progesterone were elevated in inflammation knee exudate. This suggests that these hormones present in synovial fluid may affect the local rheumatoid inflammatory processes.