Abnormal hypothalamic—pituitary—adrenal axis function in rheumatoid arthritis. Effects of nonsteroidal antiinflammatory drugs and water immersion

Abstract

Objective. To investigate the effects of nonsteroidal antiinflammatory drug (NSAID) therapy and water immersion on hypothalamic—pituitary—adrenal (HPA) axis function in rheumatoid arthritis (RA). Methods. Plasma levels of adrenocorticotropic hormone (ACTH) and serum and urine levels of cortisol were compared in untreated RA patients, NSAID‐treated RA patients, and healthy control subjects. Results. ACTH levels were significantly higher in untreated RA patients (mean ± SEM integrated area 11,377 ± 5,246 hours ng/liter) than in NSAID‐treated RA patients (2,285 ± 388 hours ng/liter) or healthy controls (1,845 ± 35.5 hours ng/liter) (P < 0.001). Serum and urine cortisol levels were not significantly different between groups. Two‐hour head‐out water immersion had no effect. Conclusion. Elevated ACTH levels without hypercortisolemia occur in untreated RA. NSAID therapy alters HPA axis response, but immersion has no effect. Copyright © 1994 American College of Rheumatology