Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Gonadotrophins Are Associated with Chronic Widespread Pain in Middle-Aged and Older Men

Tajar1,  Abdelouahid, McBeth1,  John, Bartfai2,  Gyorgy, Casanueva3,  Felipe F., Forti4,  Gianni, Kula5,  Krzysztof, Punab6,  Margus

The University of Manchester, Manchester, United Kingdom
Albert Szent-Gyorgy Medical University, Szeged, Hungary
Santiago de Compostela University, Santiago, Spain
University of Florence, Florence, Italy
University of Lodz, Lodz, Poland
United Laboratories of Tartu University Clinics, Tartu, Estonia
Arthritis Research Campaign, Chesterfield
Katholieke Universiteit Leuven, Leuven, Belgium

Purpose:

The role of sex hormones in the aetiology of chronic musculoskeletal pain is unclear. The aim of this study was to determine the influence of hypothalamic pituitary testicular axis (HPT) hormones on the occurrence of chronic widespread pain (CWP).

Methods:

Men aged 40–79 years were recruited from population registers in eight centres for participation in the European Male Aging Study (EMAS). Subjects were asked to complete a postal questionnaire which included questions about lifestyle, co-morbid illnesses and musculoskeletal pain experienced in the past month. They were asked to highlight on a body manikin the sites of any pain they had experienced. Subjects subsequently attended for assessment which included an interviewer assisted questionnaire and fasting blood sample from which total testosterone (TT), sex hormone binding globulin (SHBG), luteinising hormone (LH), and follicle-stimulating hormone (FSH) were assayed. Free testosterone (FT) was calculated from TT and SHBG using an established formula. Subjects were classified into one of three groups according to their pain reports: those reporting no pain, those with CWP, as classified using the ACR criteria, and those reporting some pain (non CWP). The association between pain status and sex hormone levels was assessed using multinomial logistic regression with results expressed as relative risk ratios (RRR) and 95% confidence intervals (CI). In all analyses the "no pain" group was the referent category.

Results:

A total of 3,184 men [mean (SD) age 60 (11) years] had complete data on sex hormones and pain status. Of these 1,304 (41.0%) reported no pain, 1,605 (50.4 %) had some pain and 275 (8.6%) had CWP. The mean (SD) for TT was 16.5 (5.9) nmol/L, FT 292.0 (93.2) pmol/L, LH 6.2 (4.5) U/L, FSH 8.7 (9.2) U/L and SHBG 42.9 (19.8) nmol/L.After adjustment for age and other putative confounders including body mass index, smoking, alcohol intake, number of co-morbidities, depression and centre, the association between higher levels of LH and FSH and pain persisted. Being in the highest tertile of LH was associated with an increased risk of having some pain (RRR = 1.3; 95% CI, 1.1, 1.5) and CWP (RRR = 1.6; 95% CI, 1.1, 2.2). Similarly, being in the highest tertile of FSH was associated with an increased risk of having some pain (RRR = 1.3; 95% CI 1.01,1.5) and CWP (RRR = 1.5; 95% CI 1.2, 2.0).

Conclusion:

Testosterone levels were similar among the pain groups with high levels of gonadotrophins (LH and FSH) among those with pain (some pain and CWP). This relationship may indicate that deficits in testicular function can be adequately compensated for in the presence of musculoskeletal pain. Further studies appear warranted to investigate these findings.

To cite this abstract, please use the following information:
Tajar, Abdelouahid, McBeth, John, Bartfai, Gyorgy, Casanueva, Felipe F., Forti, Gianni, Kula, Krzysztof, et al; Gonadotrophins Are Associated with Chronic Widespread Pain in Middle-Aged and Older Men [abstract]. Arthritis Rheum 2009;60 Suppl 10 :572
DOI: 10.1002/art.25652

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