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Androgen replacement therapy in male patients with rheumatoid arthritis
M Cutolo1, E Balleari, M Giusti
1Department of Rheumatology, University of Genoa, Italy.
Abstract:
A hypogonadic condition characterized by low serum testosterone levels has been identified in male patients with rheumatoid arthritis (RA). Seven men with active RA were treated daily for 6 months with oral testosterone undecanoate plus a nonsteroidal antiinflammatory drug in an attempt to evaluate the immunologic response, the overall clinical response, and the sex hormone response to such replacement therapy. At the end of the 6 months, there was a significant increase in serum testosterone levels (P less than 0.05), an increase in the number of CD8+ T cells, and a decrease in the CD4+:CD8+ T cell ratio. The IgM rheumatoid factor concentration decreased significantly (P less than 0.05). There was a concurrent significant reduction in the number of affected joints (P less than 0.05) and in the daily intake of nonsteroidal antiinflammatory drugs (P less than 0.01). The well-known immunosuppressive action of androgens probably contributed to our findings in these RA patients.
Insights
Testosterone replacement therapy improved immune markers and reduced disease activity in men with rheumatoid arthritis (RA). This study found significant benefits in testosterone levels, T cell counts, and joint inflammation.
Area of Science:
- Endocrinology
- Immunology
- Rheumatology
Background:
- Hypogonadism, characterized by low serum testosterone, is observed in male rheumatoid arthritis (RA) patients.
- Understanding the impact of testosterone replacement in RA is crucial for managing disease activity and immune function.
Purpose of the Study:
- To evaluate the immunologic, clinical, and hormonal responses to oral testosterone undecanoate in men with active RA.
- To assess the safety and efficacy of testosterone replacement therapy in this patient population.
Main Methods:
- Seven male patients with active RA received daily oral testosterone undecanoate and a nonsteroidal anti-inflammatory drug for six months.
- Serum testosterone levels, CD4+/CD8+ T cell counts, IgM rheumatoid factor concentration, and clinical disease parameters were monitored.
Main Results:
- Significant increases in serum testosterone levels (P < 0.05) and CD8+ T cells were observed.
- A significant decrease in the CD4+:CD8+ T cell ratio (P < 0.05) and IgM rheumatoid factor concentration (P < 0.05) was noted.
- Concurrent significant reductions in affected joints (P < 0.05) and NSAID intake (P < 0.01) were achieved.
Conclusions:
- Oral testosterone undecanoate therapy effectively increased testosterone levels and modulated immune responses in RA patients.
- Testosterone replacement demonstrated a positive clinical impact, reducing joint inflammation and reliance on NSAIDs.
- The immunosuppressive properties of androgens likely contribute to the observed therapeutic benefits in rheumatoid arthritis.