Abstract
Background Results of studies on hypothalamic-pituitary-adrenal axis (HPA-axis) function amongst patients with chronic widespread pain (CWP) are equivocal and well-controlled cohort studies are rare in this field.
Objectives The goal of our study was to examine whether HPA-axis function is associated with the presence and the severity of CWP.
Methods Data are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of CWP. Subjects were categorized into a CWP group (n=471) and a control group (n=654). Salivary cortisol samples were collected to assess HPA-axis function (1-h awakening response, evening level, diurnal slope and post-dexamethasone level).
Results In comparison with the control group, subjects with CWP showed significantly lower awakening levels and a blunted diurnal slope, in particular among those without depressive/anxiety disorders. CWP subjects with depressive and/or anxiety disorders did not show altered cortisol levels.
Conclusions Our results suggest hypocortisolemia in CWP. However, if CWP is accompanied by depressive or anxiety disorder, typically related to hypercortisolemia1,2, the association between cortisol levels and CWP appears to be masked. Future studies should take psychopathology into account when examining HPA-axis function in CWP.
Objectives The goal of our study was to examine whether HPA-axis function is associated with the presence and the severity of CWP.
Methods Data are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of CWP. Subjects were categorized into a CWP group (n=471) and a control group (n=654). Salivary cortisol samples were collected to assess HPA-axis function (1-h awakening response, evening level, diurnal slope and post-dexamethasone level).
Results In comparison with the control group, subjects with CWP showed significantly lower awakening levels and a blunted diurnal slope, in particular among those without depressive/anxiety disorders. CWP subjects with depressive and/or anxiety disorders did not show altered cortisol levels.
Conclusions Our results suggest hypocortisolemia in CWP. However, if CWP is accompanied by depressive or anxiety disorder, typically related to hypercortisolemia1,2, the association between cortisol levels and CWP appears to be masked. Future studies should take psychopathology into account when examining HPA-axis function in CWP.
Original language | English |
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Article number | eular.1497 |
Pages (from-to) | 444 |
Number of pages | 1 |
Journal | Annals of the Rheumatic Diseases |
Volume | 73 |
Issue number | Supplement 2 |
Publication status | Published - 2014 |