STATE OF HORMONAL COMPONENT OF STRESS-REALIZING AND STRESS-LIMITING SYSTEM IN CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS AT THE SANATORIUM STAGE OF REHABILITATION
The purpose of research - to study the state of the hormonal component of stress-realizing (ACTH, cortisol) and stress-limiting (melato-nin) systems in patients with juvenile rheumatoid arthritis at the sanatorium stage of rehabilitation.Material and methods. At the sanatorium stage of rehabilitation we were examined 95 children aged 4-16 years suffering from the JRA.The quantitative concentration of cortisol and adrenocorticotropic hormone (ACTH) was determined by solid-phase enzyme-linked immu-nosorbent assay in serum. The content of melatonin in the body was judged by the concentration of its main metabolite 6-sulfatoxymela-tonin (6-COMT) in the urine. The examination in all groups of children was carried out in the spring-summer period (from April to July), in order to exclude seasonal uctuations in the level of this hormone. Statistical processing of data was carried out using nonparametric statistics using a computer package of data processing Statistica v 6. To evaluate the degree of correlation, a correlation analysis was performed with calculation of the Spearman correlation coefcients (r). Results. The study revealed that ACTH secretion is signicantly lower in patients with JRA than in healthy peers. At the same time, the level of cortisol was 2.5 times higher in comparison with children of CH. The lowest levels of ACTH were found in patients with a second degree of activity and duration of the disease for more than 3 years. As for the initially elevated cortisol level, its decrease was revealed in the joint-visceral form of JRA and the duration of the disease for more than 6 years. The lack of correlation between ACG and cortisol indicates a violation of the internal mechanism of regulation of the activity of the stress-realizing system. In children with JRA, the daily content of melatonin was signicantly (p <0.001) lower, compared with CH. There was also an inversion of the rhythm of its secretion, due to an increase in the daytime (210.04 ± 12.45 ng / ml, p <0.001) and a decrease in the nighttime level (21.31 ± 2.07 ng / ml, p <0.001). Were most pronounced in the joint-visceral form of the disease, the second degree of activity and the duration of the pathological process for more than 6 years. The correlation analysis of the parameters studied in patients with JRA revealed a negative relationship between the nocturnal melatonin level and the degree of activity (r = -0.363; p <0.05) and the duration of morning stiffness (r = -0.347; p <0.05); Between daily (r = -0.502, p <0.01), daytime (r = -0.484, p <0.01) levels of melatonin and the duration of the disease.Conclusion. 1. The peculiarities of the functioning of the stress-realizing system, characterized by multidirectional changes in the indices of the main “stressor” hormones (ACTH, cortisol), are revealed in JRA patients, which indicates neuroendocrine disintegration and stress reactivity increased.2. It has been established that in patients with JRA there is a decrease in quantitative production and an inversion of the rhythm of melatonin secretion, which indicate an imbalance in the stress-limiting system and the formation of internal disinchronosis.3. Violation of the internal mechanism of restriction of activity of the stress-realizing system, carried out on the principle of feedback in the pituitary-adrenal system, as well as a decrease in the functionality of the stress-limiting system, is revealed, which leads to the failure of the external mechanism for limiting the stress response in patients with JRA.