The adrenal steroid status in relation to inflammatory cytokines (interleukin-6 and tumour necrosis factor) in polymyalgia rheumatica

Objective. To determine the correlation between inflammatory cytokines and adrenal hormones in patients with polymyalgia rheumatica (PMR) and to compa re the ratio of serum cortisol and androstenedione (ASD) or dehydroepiandro sterone sulphate(DHEAS) in normal subjects with PMR patients. Methods. In 102 patients with PMR (32 beginning and 70 chronic disease) and 31 age-matched and sex-matched healthy subjects, ASD, cortisol, DHEAS, int erleukin-6 (IL-6), and tumour necrosis factor (TNF) were measured by immuno metric assays. Results. Serum levels of IL-6 were elevated in patients with PMR as compare d with normal subjects (10.0 +/- 1.6 vs 2.1 +/- 0.1 pg/ml, P = 0.01), which was not found for TNF. In PMR patients, serum levels of IL-6 were positive ly correlated with serum levels of ASD (P < 0.001), cortisol (P < 0.001), a nd DHEAS (P = 0.038) irrespective of corticosteroid treatment. Serum levels of cortisol in relation to IL-6 were significantly lower in patients with chronic disease and long-standing corticosteroid administration as compared with patients with recent onset of the disease and without corticosteroid therapy (P < 0.01). Conclusions. Tn PMR, as expected, there was an increase in IL-6 serum level s that was associated with elevated serum levels of ASD, DHEAS, and cortiso l which was more marked in patients with recent-onset disease and without c orticosteroids. However, serum levels of cortisol in patients with and with out corticosteroids were lower than expected by considering the inflammator y status (increased IL-6). This may indicate a change in the hypothalamic-p ituitary-adrenal (HPA) axis responsiveness to inflammatory stimuli such as IL-6 during chronic disease. Furthermore, there seems to be a shift of bios ynthesis to cortisol in relation to DHEAS or ASD in chronic disease.