A naturalistic evaluation of cortisol secretion in persons with fibromyalgia and rheumatoid arthritis

Objective. To compare cortisol levels, diurnal cycles of cortisol, and reac tivity of cortisol to psychological stress in fibromyalgia (FM) and rheumat oid arthritis (RA) patients in their natural environment, and to examine th e effect on results of accounting for differences among the groups in psych ological stress and other lifestyle and psychosocial variables. Methods. Participants were 22 FM patients, 18 RA patients, and 22 healthy c ontrols. Participants engaged in normal daily activities were signaled with a preprogrammed wristwatch alarm to complete a diary (assessing psychosoci al- and lifestyle-related variables) or provide a saliva sample (for cortis ol assessment). Participants were signaled to provide 6 diary reports and 6 saliva samples on each of two days. Reports of sleep quality and sleep dur ation were also made upon awakening. Results. FM and RA patients had higher average cortisol levels than control s; however, there were no differences between the groups in diurnal cycles of cortisol or reactivity to psychological stress, While the groups differe d on stress measures, surprisingly, the patient groups reported less stress . Furthermore, statistically accounting for psychosocial- and life-style-re lated differences between the groups did not change the cortisol findings. Conclusion. The results provide additional evidence of hypothalamic-pituita ry-adrenal axis disturbance in FM and RA patients, While such elevations ar e consistent with other studies of chronically stressed groups, the elevati ons in cortisol in this study did not appear to be due to ongoing daily str ess, and there was no evidence of disturbed cortisol reactivity to acute st ressors.