PROLONGED HYPOGONADISM IN MALE PATIENTS WITH RHEUMATOID ARTHRITIS DURING FLARES IN DISEASE ACTIVITY

The pituitary-gonadal axis was assessed in 10 male patients during hospital admissions lasting 3–6 weeks (median 3 weeks) for flares for rheumatoid arthritis. Despite significant improvements in the Ritchie indices from median 16 (range 9–23) to 8.5 (range 5–20) (p<0.01) and ESR from median 67 mm/h (range 46–115 mm/ h) to 58 mm/h (range 15–116 mm/h) (p<0.05) there were no significant changes in serum testosterone, LH, FSH, prolactin (PRL), cortisol or androstenedione during the admission periods. At follow-up (median 14 months, range 5–18 months after admission) there were further improvements in articular indices (median 7, range 3–13; p = NS) and ESR (median 20 mm/h, range 4–62 mm/h; p<0.05) and rheumatoid factor titres had fallen from median 1/1025 (range 1/126 to 1/1024) to median 1/512 (range 1/64 – 1/512). One patient showed biochemical features of progressive testicular failure. In the remaining patients, serum and derived free testosterone levels were significantly increased (p<0.01 respectively) and serum LH reduced (p<0.01). There were no changes, at this time, in prolactin, cortisol or androstenedione. Rheumatoid flares appear to be associated with prolonged suppression of testicular function.