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Effects of Dehydroepiandrosterone Supplement on Health-related Quality of Life in Glucocorticoid Treated Female Patients with Systemic Lupus Erythematosus
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (systemisk autoimmunitet)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Biologiska membran)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2005 (English)In: Autoimmunity, ISSN 0891-6934, Vol. 38, no 7, 531-540 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to evaluate the efficacy of low dose dehydroepiandrosterone (DHEA) on health-related quality of life (HRQOL) in glucocorticoid treated female patients with systemic lupus erythematosus (SLE). Forty one women ( >or= 5 mg prednisolone/day) were included in a double-blind, randomized, placebo-controlled study for 6 months where DHEA was given at 30 mg/20 mg ( or= 46 years) daily, or placebo, followed by 6 months open DHEA treatment to all patients. HRQOL was assessed at baseline, 6 and 12 months, using four validated questionnaires and the patients' partners completed a questionnaire assessing mood and behaviour at 6 months. DHEA treatment increased serum levels of sulphated DHEA from subnormal to normal. The DHEA group improved in SF-36 "role emotional" and HSCL-56 total score (both p<0.05). During open DHEA treatment, the former placebo group improved in SF-36 "mental health" (p<0.05) with a tendency for improvement in HSCL-56 total score (p=0.10). Both groups improved in McCoy's Sex Scale during active treatment (p<0.05). DHEA replacement decreased high-density lipoprotein (HDL) cholesterol and increased insulin-like growth factor I (IGF-I) and haematocrit. There were no effects on bone density or disease activity and no serious adverse events. Side effects were mild. We conclude that low dose DHEA treatment improves HRQOL with regard to mental well-being and sexuality and can be offered to women with SLE where mental distress and/or impaired sexuality constitutes a problem.

Place, publisher, year, edition, pages
2005. Vol. 38, no 7, 531-540 p.
Keyword [en]
Adjuvants; Immunologic/pharmacology/*therapeutic use, Adult, Aged, Androgens/blood, Corticotropin/blood, Dehydroepiandrosterone/pharmacology/*therapeutic use, Double-Blind Method, Female, Humans, Insulin-Like Growth Factor I/metabolism, Lupus Erythematosus; Systemic/blood/*drug therapy/*physiopathology, Middle Aged, Prednisolone/pharmacology/*therapeutic use, Quality of Life, Research Support; Non-U.S. Gov't, Sex Characteristics, Sex Hormone-Binding Globulin/metabolism
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93511DOI: 10.1080/08916930500285550PubMedID: 16373258OAI: oai:DiVA.org:uu-93511DiVA: diva2:167006
Available from: 2005-10-05 Created: 2005-10-05 Last updated: 2013-07-30Bibliographically approved
In thesis
1. Clinical and Experimental Studies in Primary Sjögren’s Syndrome and Systemic Lupus Erythematosus
Open this publication in new window or tab >>Clinical and Experimental Studies in Primary Sjögren’s Syndrome and Systemic Lupus Erythematosus
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Autoimmune mechanisms and genetic susceptibility contribute to the pathogenesis of primary Sjögren’s syndrome and SLE. These chronic systemic autoimmune diseases have many serological and clinical features in common and have an impact on daily life. The studies in this thesis aim to elucidate their autoimmune mechanisms, define susceptibility genes and evaluate effects of androgen supplement on health-related quality of life.

Autoantibodies against α-fodrin, a widely distributed cytoskeletal protein, were detected at similar frequencies in sera from patients with primary and secondary Sjögren’s syndrome and SLE. Consequently, testing for antibodies against α-fodrin would not add diagnostic value compared to conventional serological analysis and does not discriminate between these diseases.

The type I interferon (IFN) system was found to be activated in primary Sjögren’s syndrome. IFN-α containing cells were detected in minor salivary gland biopsies, while sera from patients with primary Sjögren’s syndrome induced IFN-α production in the presence of apoptotic and necrotic cell material. This ability of sera correlated with the presence of antibodies against RNA-binding proteins and IFN-α production was dependent on RNA in immune complexes. The natural interferon producing cells/plasmacytoid dendritic cells (NIPC/PDC) were the IFN-α producers and blocking of FcγRIIa inhibited the production. Single nucleotide polymorphisms (SNPs) in two genes in the type I IFN signalling pathway, those for tyrosine kinase 2 and interferon regulatory factor 5, were strongly associated with SLE in a Swedish, Finnish and Icelandic population. The minor allele frequencies were lower in SLE patients than in healthy controls. These SNPs may decrease the function of the type I IFN system, thereby conferring protection against SLE.

Supplementation with dehydroepiandrosterone (DHEA) in glucocorticoid treated women with SLE led to mild improvements in health-related quality of life in respect of mental well-being and sexuality, whereas physical well-being was unaffected.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 76 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 73
Keyword
Medicine, Sjögren’s syndrome, SLE, α-fodrin, interferon-α, single nucleotide polymorphism, dehydroepiandrosterone, Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:uu:diva-5943 (URN)91-554-6349-5 (ISBN)
Public defence
2005-10-28, Rudbecksalen, Rudbecklaboratoriet, Uppsala, 13:15
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Available from: 2005-10-05 Created: 2005-10-05 Last updated: 2012-03-30Bibliographically approved

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Nordmark, GunnelLarsson, AndersKarlsson, AndersRönnblom, Lars

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