Differences in systemic measures of GC metabolism in patients with early arthritis and established RA. Systemic measures of 11β-HSD1 activity in patients with early arthritis of different outcomes and established RA: (THF + 5αTHF)/THE ratio (A) and cortols/cortolones ratio (B). UFF/UFE ratio, an indicator of changes in renal 11β-HSD2 activity (C). 5αTHF/THF, a systemic measure of 5α-reductase activity (D). Values for (THF + 5αTHF)/THE ratio, cortols/cortolones ratio and 5αTHF/THF ratio were normally distributed whereas values for UFF/UFE ratio were not normally distributed. Individual values and means are represented on the graph. Comparisons between different outcome groups for normally distributed urine corticosteroid metabolite ratios ((THF + 5αTHF)/THE and cortols/cortolones) were carried out using the unpaired t test. Comparisons between different outcome groups for non-normally distributed urine corticosteroid metabolite ratios (UFF/UFE and 5αTHF/THF) were carried out using the Mann-Whitney test. A P value <0.05 was considered statistically significant. Patients with early resolving arthritis (circles), all patients with early persistent arthritis (squares), early persistent RA (upward triangles) and established RA (downward triangles). 11β-HSD, 11β-hydroxysteroid dehydrogenase type 1; GC, glucocorticoids; RA, rheumatoid arthritis; (THF + 5αTHF)/THE ratio, (tetrahydrocortisol + 5αtetrahydrocorticol)/tetrahydrocortisone ratio; UFF/UFE ratio, urinary-free cortisol/cortisone ratio.