DECREASED TESTOSTERONE LEVELS IN MEN WITH RHEUMATOID-ARTHRITIS - EFFECT OF LOW-DOSE PREDNISONE THERAPY

Objective. To determine whether men with rheumatoid arthritis (RA) hav e abnormal hypothalamic pituitary-gonadal axis function and to measure the effects of low dose prednisone therapy in these patients. Methods . We measured testosterone, follicle stimulating hormone (FSH), and lu teinizing hormone (LH) in 36 men aged 38-75 (mean age +/- 1 sd = 62 +/ - 10 years) who had longstanding active RA (mean disease duration = 17 +/- 12 years) and in 70 healthy elderly male controls, aged 53-83 (me an age 68 = +/- 6 years). We divided the group with RA into those taki ng no prednisone (n = 12) and those taking 5 to 10 mg/day of prednison e (n = 24) and analyzed these groups separately to determine whether l ow doses of prednisone affected testosterone levels. Results. Compared to the healthy controls, patients with RA not taking prednisone had n ormal testosterone levels but significantly elevated levels of FSH and LH (p <0.01 for both comparisons). In contrast, patients with RA taki ng prednisone had significantly lower testosterone levels (p <0.05), b ut levels of FSH and LH were only slightly elevated compared to contro ls. Compared to patients not taking prednisone, patients taking predni sone had lower levels of testosterone, FSH, and LH. Conclusion. Male p atients with RA who are not taking prednisone have significantly eleva ted levels of FSH and LH with normal testosterone levels, suggesting a state of compensated partial gonadal failure. Male patients with RA t aking low doses of prednisone have lower testosterone and gonadotropin levels, suggesting that prednisone may suppress the hypothalmic-pitui tary-testicular axis. Since testosterone affects immune function as we ll as bone and muscle metabolism, androgen deficiency in some men with RA may predispose these patients to more severe disease and to increa sed complications of steroid therapy such as myopathy and osteoporosis .