Rheumatoid arthritis - a neuroendocrine immune disorder: glucocorticoid resistance, relative glucocorticoid deficiency, low-dose glucocorticoid therapy, and insulin resistance

Rheumatoid arthritis - a neuroendocrine immune disorder: glucocorticoid resistance, relative glucocorticoid deficiency, low-dose glucocorticoid therapy, and insulin resistance

sighted work of Philip S Hench, who together with Edward C Kendall and Tadeus Reichstein introduced glucocorticoids (GCs) into clinical medicine. Since the 1990s, more than 40 years after adding GC to the therapeutic armamentarium, important work has been carried out to understand GC action. Th ere were three major pathways of discoveries between 1990 and today. Firstly, the groups of George Ch...

Neuroendocrine-immune interactions in rheumatoid arthritis: mechanisms of glucocorticoid resistance.

Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovial membrane, leading to joint destruction. Many autoimmune diseases and disease states of chronic inflammation are accompanied by alterations in the complex interactions between the endocrine, nervous and immune systems. Glucocorticoids, an end product of the hypothalamic-pituitary-adrenal axis, are a mainstay treat...

Glucocorticoid management in rheumatoid arthritis: morning or night low dose?

Morning symptoms of rheumatoid arthritis (RA) are linked to circadian increase of night inflammation, supported by inadequate cortisol secretion in active disease. Therefore, exogenous glucocorticoid administration in RA is recommended by EULAR and ACR from the beginning of the diagnosis, since may partially act like a "replacement therapy". In addition, the prevention/treatment of the night up...

Familial/Sporadic Glucocorticoid Resistance

Glucocorticoid treatment in rheumatoid arthritis: low-dose therapy does not reduce responsiveness to higher doses.

BACKGROUND Despite low-dose gluco-corticoid (GC) treatment, many patients with rheumatoid arthritis (RA) require additional flare therapy with GC at higher doses. Since low dose GC has been suggested to confer resistance to higher doses, we aimed to assess if resistance was detectable on the clinical level in patients with active RA. METHODS Eighty-nine patients with active RA (Disease Activi...