Ghrelin was first identified in 1999 as an endogenous ligand for the growth hormone secretagogue receptor [
1]. It has a strong stimulatory effect on growth hormone secretion, and the effect is at least partially mediated through the stimulation of the pituitary growth hormone secretagogue receptor [
2,
3]. Ghrelin is a 28-amino acid peptide predominantly produced by the stomach, although its expression has been reported in the bowel, pancreas, pituitary gland, hypothalamus, placenta, gonads and adipose tissue [
4]. The main physiological role of ghrelin is involvement in the control of food intake and energy homeostasis [
5]. Serum ghrelin level was found to be increased in malnutrition and cachexia [
6]. In children with congenital heart disease, a positive correlation between elevated ghrelin and TNF-α was found [
7]. Ghrelin is released into blood and causes an increase in food intake and reduces fat utilization [
8]. It also antagonizes leptin through the activation of the hypothalamic neuropeptide Y/Y1 receptor pathway [
9]. A few other effects of ghrelin have been reported. Ghrelin has been demonstrated to stimulate the vagal efferent nerve [
10]. Additionally, ghrelin exerts multiple immunoregulatory effects. Ghrelin was reported to down-regulate TNF-α and interleukin-6 in sepsis in rats [
10]. Li et al. [
11] have found that ghrelin inhibits proinflammatory response and nuclear factor
KB activation in human endothelial cells.
Rheumatoid arthritis is a chronic inflammatory disease affecting primarily joints. TNF-α is suggested to be a key cytokine in the development and propagation of inflammation, and TNF-α blocking agents are used in the last decade as relatively successful drugs limiting inflammation in patients with rheumatoid arthritis [
12]. Otero et al. [
13] reported decreased levels of ghrelin in rats with adjuvant-induced arthritis and rheumatoid arthritis patients. Recently, Gonzalez-Gay et al. [
14] described an increase in ghrelin level immediately after infusion of infliximab in patients with rheumatoid arthritis. On the other hand, Maruna et al. [
15] suggested that ghrelin is an acute-phase reactant and its level is elevated during postoperative period. Ghrelin was also found to be increased in patients with vasculitis [
16].
The present study was designed to determine serum ghrelin level in patients with active rheumatoid arthritis without significant reduction in body weight before and after 1 year of treatment with TNF-α blocking agent, infliximab.