Sex Hormone Status And Its Relation With IL-6 In Postmenopausal Women With Rheumatoid Arthritis

Objective:Rheumatoid arthritis is one of the most common autoimmune diseases. It has a 3:1 F:M ratio, and is modulated by pregnancy and menstrual cycles. The peak age of onset in women is 45⁵5 years, implicating the menopauseas a possible trigger in some. All these suggest that sex hormones are somehow involved in its etiology. The aim of present study was to measure DHEAS, Te, E₂ concentrations in serum and synovial fluid in the postmenopausal women with rheumatoid arthritis (PRA) and to investigate the correlation between these hormones and IL-6. Furthermore to understand the role of the neuroendocrine-immune system in the pathogenesis of PRA. Methods:Serum and synovial fluid sex hormones (DHEAS, Te and ?) were measured by radioimmunoassay in patients with PRA and healthy controls, whereas IL-6 were measured by enzyme-linked immunosorbant assay (ELISA). Values are given as median (M) and inter-quartile range (Qu-Qi). Nonparametric tests Wilcoxon's test and the Spearman rank correlation coefficient were used to analyse the date. A p value of 0.05 was considered significant.Results:1. The DHEAS level in serum of patients with PRA was lower than that of healthy controls (PO.05).2. The Te level in serum of patients with PRA was lower than that of healthy controls, but had no statistical significant (P>0.25).3. Serum level of ? in PRA showed no difference compared normal person (P>0.05).4. Serum level of IL-6 in PRA was significantly higher than that of healthy controls (PO.05).5. PRA patients, their Te level was lower in SF than in serum (PO.05); their IL-6 level was higher in SF than in serum (PO.05), but DHEAS and E2 levels showed no difference in SF and in serum (P>0.05).6. Both in serum and SF, DHEAS levels were negatively correlatedwith IL-6 levels (PRA serum: rs =-0.572; healthy serum: rs = -0.459; PRASF: rs =-0.553. PO.01).7. Both Te and ? had no correlation with IL-6 in serum and SF (PRA serum: rs(Te) =0.172 rs(E,) =-0.256; healthy serum: rs(Te)= 0.032 rs(E;,=-0.146;PRA SF: rs(Te)= -0.316 rs(E;) = 0.029 , P>0.05). Conclusion:1. Serum level of DHEAS in PRA patients is significantly decreased than healthy controls, the serum level of Te in PRA patient is lower than healthycontrols, but have no statisticaly significant. These indicate that sex hormone levels abnormalities especially decreased DHEAS levels may be a predisposing factor of PRA, and adrenal function may be deficiency in PRA patients.2. No differences were noted in the concentrations of serum ? between PRA patients and their healthy controls. This indicates that ? do not play an important role in the pathophysiology.3. IL-6 concentration in PRA serum is significantly increased, and the level of IL-6 in SF is striking elevated than in serum, these imply that IL-6 participate in the systemic inflammatory process in PRA, and its local effect may be more important.4. Both in serum and in SF, DHEAS levels were negatively correlated with IL-6 levels. So, IL-6 may be an important factor mediating interactions between the immune system and neuroendocrine system.5. On basis of a more complete understanding of the pathogenic role of the neuroendocrine-immune network in PRA, on both a local and systemic level, we believe that combined therapeutic approaches on a neuroendocrine immune basis are of crucial importance in a pathogenetically oriented therapy of RA.