Glucocorticoid Metabolism in Inflammatory Arthritis
Author Information
Author(s): Hardy R, Rabbitt E H, Filer A, Emery P, Hewison M, Stewart P M, Gittoes N J, Buckley C D, Raza K, Cooper M S
Primary Institution: University of Birmingham
Hypothesis
How does intact synovial tissue metabolize glucocorticoids and what are the local and systemic consequences of this activity in patients with rheumatoid arthritis?
Conclusion
Synovial tissue metabolizes glucocorticoids, primarily activating them, and this activation increases with inflammation.
Supporting Evidence
- Synovial tissue synthesized cortisol from cortisone, confirming functional 11β-HSD1 expression.
- Inhibitor studies suggested that 11β-HSD2 expression in synovial macrophages was responsible for converting cortisol back to cortisone.
- Urinary analyses indicated high 11β-HSD1 activity in untreated patients with RA compared with controls.
Takeaway
The study found that the tissue around joints in people with rheumatoid arthritis can change inactive steroids into active ones, which can affect inflammation and bone health.
Methodology
Synovial tissue was taken from patients during joint replacement surgery, and glucocorticoid metabolism was assessed using chromatography and enzyme inhibitors.
Potential Biases
Potential bias due to the small sample size and the treatment history of the patients.
Limitations
The small number of patients and the fact that they were on various treatments make it hard to generalize the findings.
Participant Demographics
12 patients with rheumatoid arthritis (mean age 62 years, 11 females, 1 male) and 8 patients with osteoarthritis (mean age 67 years, 6 females, 2 males).
Statistical Information
P-Value
p<0.001
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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