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Hormone Concentrations in Synovial Fluid of Patients with Rheumatoid Arthritis J

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Hormone Concentrations in Synovial Fluid of Patients with Rheumatoid Arthritis J Hormone concentrations in synovial fluid of patients with rheumatoid arthritis J. Rovensky1, R. Kvetnansky2, Z. Radikova2, R. Imrich2, O. Greguska1, M. Vigas2, L. Macho2 1National Institute for Rheumatic Diseases, Piestany; 2Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia. Abstract Objective Alterations in local concentrations of hormones, affecting directly synovial cells, could be involved in the modulation of the rheumatic inflammatory processes. The aim of present study was to investigate the levels of select- ed hormones (steroids, peptide and thyroid hormones) in synovial fluid of knee joint of patients with rheumatoid arthritis (RA) and control individuals with non-rheumatic exudate (with osteoarthrosis, OA). Methods Thirty-eight patients, 22 female and 16 males, with rheumatoid arthritis (RA) and 12 subjects with osteoarthrosis (OA, control group, 6 females and 6 males) participated in the study. Concentrations of cortisol (CS), 17- estradiol (ES), dehydroepiandrosterone (DHEA), progesterone (PRG), aldosterone ALD), prolactin (PRL), insulin (INS), and C-peptide were determined by radioimmunoassay in synovial fluid. Insulin binding to isolated cell membrane of cells from synovial sediment was estimated by using radioiodine labeled insulin. In a group of patients (10 with RA and 4 with OS), the levels of free threeiodothyronine (FT3), TSH and growth hormone (GH) were also determined in synovial fluid. Results Increased levels of ES in synovial fluid of RA patients were observed, and higher differences were noted in men. TE concentrations were moderately elevated in synovial fluid of RA patients, however the ratio of ES/TE was significantly higher in male RA compared to OA patients. Higher levels of PRG, ALD and growth hormone were noted in synovial fluid of RA patients. Besides the steroid hormones the presence of insulin and C-peptide was noted in synovial fluid and the correlation between the levels of these two peptides was highly significant. The concentrations of INS and C-peptide in synovial fluid of patients from RA and OA group were not significantly different, however, highly significant increase of insulin binding to isolated membrane of synovial cells was found. Concentrations of cortisol, dehydroepiandosterone, prolactin, TSH and FT3 in synovial fluid were not significantly different in RA and OA groups. Conclusions Besides the steroids also insulin, c-peptide, GH and FT3 were found in synovial fluid. The elevated ALD and GH levels in synovial fluid of RA patients and the presence of INS in synovial fluid with increase of INS binding to plasma membranes of cells from synovial fluid of RA patients suggest that besides the gonadal steroids also these hormones may affect the local inflammatory processes. Key words Rheumatoid arthritis, arthrosis, synovial fluid, hormone content. Clinical and Experimental Rheumatology 2005; 23: 292-296. Hormones in synovial fluid of RApatients / J. Rovensky et al. This study was supported by grants VTP Introduction consent. The Institute Ethical Commit- 21-06-01/98 and APVT21-008602 and Rheumatoid arthritis (RA) represents a tee approved the study. by the Ministry of Health of the Slovak multifactorial autoimmune rheumatic All patients underwent routine labora- Republic. disease that may originate from the pa- tory testing including red blood cell Please address correspondence to: tient’s excessive immune and inflam- sedimentation rates, acute inflammato- Pr of. Jozef Rovensky, MD, DSc, Direc t o r , matory response possibly to pathogenic ry phase reactant (C-reactive protein), National Institute for Rheumatic Diseases, Nabr. I. Krasku 4, 921 01 Piestany antigen, which is handled without com- rheumatoid factor (as determined by Slovakia. plication in normal individuals (1). the latex fixation and hemaglutination Received on September 19, 2003; accepted Dysfunction of endocrine system is tests). Moreover, clinical assessment in revised form on January 26, 2005. very likely one of the important risk was performed (duration and clinical © Copyright CLINICALAND EXPERIMEN- factors involved in the pathogenesis of activity of disease, X-ray stage, previ- TAL RHEUMATOLOGY 2005. RA. It was repeatedly demonstrated ous therapy). The patients were on that steroids (glucocorticoids, estro- therapy with non-steroid antirheumat- gens and androgens) and neurohor- ics at the time of investigation, which mones are able to modulate tissue spe- were withdrawn 3 days before investi- cific immune responses (2-4). gations. The part of patients was treat- Apart from the central neuroendocrine ed with steroids (18 persons) and the regulatory mechanisms of immune re- last application of intraarticular gluco- sponses, alterations in local concentra- corticoids was 7 to 15 months before tions of hormones affecting directly sy- investigation. Patients on hormonal novial cells, mononuclear cells and lym- therapy (estrogens or androgens) and phocytes could be involved in the mod- with diabetes mellitus were excluded ulation of the immune response of tis- from the study. sues and rheumatic inflammatory pro- Synovial fluids from RA and OA pa- cess (3,5, 6). Besides the gonadal ster- tients were taken by arthrocentesis of oids, affecting local RA symptoms by knee joints. The exudates were centri- changes in cytokine production, also fuged, and differential cell counts were other hormones (e.g. prolactin, growth determined in the sediment. Superna- hormone, aldosterone, insulin) may tants were kept frozen until hormone play a role in the pathogenic mecha- analysis. The inflammatory and control nisms underlying RA (7-9). Therefore exudates were classified according to the studies of the concentrations of hor- Rovensky and Lukac (11). mones in synovial fluid with effects on Concentrations of the following hor- immune and connective tissues are of mones were determined in clear super- key significance with respect to clarifi- natant of synovial fluids: cortisol, (CS), cation of RA pathogenesis (10). The prolactin (PRL), aldosterone (ALD), aim of present study was to investigate testosterone (TE), 17-b-estradiol (ES), the levels of selected hormones (ster- dehydroepiandrosterone (DHEA), pro- oids, peptide and thyroid hormones) in gesterone (PRG), insulin (INS), and C- synovial fluid of knee joint of patients peptide. In addition to these hormones with RA and control individuals with the levels of free threeiodothyronine non-rheumatic exudate (with osteo- (FT3), thyrotropin (TSH) and growth arthrosis, OA). hormone (GH) were also determined in samples synovial fluids of 10 RAand 4 Patients and methods OApatients. The concentrations of hor- Thirty eight inpatients with rheumatoid mones were measured using radioim- arthritis (RA group, 22 females – mean munoassay kits (Immunotech, Mar- age 47.8 ± 4.6 and 16 males – mean age seille, France). The binding of insulin 52.4 ± 4.9, duration of RA 4.5 ± 1.0 to plasma membrane of cells from syn- years) admitted to the Research Insti- ovial fluid was determined according tute for Rheumatic Diseases (Piestany, to Macho et al. (12). Slovakia) and 12 patients with osteo- The results are reported as means ± arthrosis (OA group, 6 females – age SEM. Results for each variable were 61.8 ± 3.6 and 6 males – age 58.4 ± 4.7 tested for normality distribution using duration of disease 2.2 ± 0.5 years) as a Kolmogorov-Smirnov method. Results control group, participated in the study. not normally distributed were logarith- All subjects gave written informed mically transformed for statistical an- 293 Hormones in synovial fluid of RApatients / J. Rovensky et al. alysis. Wilcoxon rank sum test was Fig. 1. Levels of 17-b- used to determine whether two experi- estradiol in synovial fluid of patients with rheuma- mental values (in RA and OA groups) toid arthritis (RA) and were significantly different. Simple lin- osteoarthrosis (OA). ear regression analysis was performed F: females; M: males; to correlate hormone levels with age or means ± SE. *RA:OA p < 0.05; **RA: OAp < 0.01. with cell number in synovial fluid. General linear model (univariate) with age adjustment was used for compari- son of values in RA and OA groups using SPSS 11.0 software. Results The comparison of the levels of 17-b- estradiol in synovial fluids of patients with RA to OA showed that the levels of estradiol were increased in RA pa- Fig. 2. Te s t o s t e r o n e concentrations in syn- tients (Fig. 1). The analysis of the cor- ovial fluid of patients relation of synovial estradiol levels to with rheumatoid arth- cell number in synovial fluid (which ritis (RA) and osteo- indicates a degree of inflammatory pro- arthrosis (OA). F: females, M: males, cesses) demonstrated a highly positive means ± SE, * RA:OA correlation (p < 0.021). Te s t o s t e r o n e p < 0.05. concentrations were moderately higher in inflammatory synovial fluids from RA patients as compared to values in OAcontrols (Fig. 2). The ratio of 17-b- estradiol/testosterone concentrations in synovial fluid from knee joints of male R A patients was significantly higher (0.077 ± 0.020) compared to males in OAgroup (0.017±0.08, p< 0.05), how- ever; significant differences were not observed in females. Higher concentra- tions of progesterone were found in sy- patients as compare to OA, however, tions of estrogen to androgen is, how- novial fluid of RA patients (Table I) insulin binding to isolated membrane ever; important for their modulatory and no differences were noted in estro- of cells from sediment of knee exudates action on the activity of immune sys- gen to progesterone ratio in RAand OA was significantly higher in RA patients tem (3). In agreement with previous patients. The aldosterone concentra- when compared to control group (Fig. findings (2, 3, 6) we have observed ele- tions showed higher values in synovial 3). The concentrations of C-peptide vated levels of 17-b estradiol in syn- fluids from RA patients (Table I) and detected in synovial fluids were com- ovial fluid of knee joint of patients with positive correlation of aldosterone con- parable in RAand OAgroups (Table I).
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