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首页> 外文期刊>International journal of clinical rheumatology. >Alleviation of morning joint stiffness by low-dose prednisone in rheumatoid arthritis is associated with circadian changes in IL-6 and cortisol
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Alleviation of morning joint stiffness by low-dose prednisone in rheumatoid arthritis is associated with circadian changes in IL-6 and cortisol

机译：类风湿关节炎中低剂量泼尼松缓解晨关节僵硬与IL-6和皮质醇的昼夜变化有关

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Aim: The effect of prednisone on the morning joint stiffness of rheumatoid arthritis (RA) is enhanced by night-time (2 am) administration. It has been hypothesized that this may be due to suppression of the pathological early-morning rise in plasma IL-6, but this has not yet been measured. A theoretical disadvantage of night-time prednisone is increased suppression of the hypothalamic-pituitary-adrenal axis and reduced peak plasma cortisol levels, usually attained at approximately 7 am. This study measured 24-h variations in IL-6, other cytokines and cortisol in patients before and after a 2-week course of nighttime prednisone to address both these questions. Materials & methods: Nine patients with active RA were clinically assessed and had 24-h blood sampling before and after a 2-week course of timed-release tablet (TRT) prednisone (5 mg per day). Patients took the TRT orally at 10 pm and the prednisone was released at 2 am. Changes in circadian variation in cortisol and IL-6 and clinical measures were compared using regression modeling and Wilcoxon matched-pairs signed-rank test. Cytokines IL-1 receptor antagonist, IL-1p, IL-4 and TNF were also measured. Results: Significant alterations in the circadian profiles and concentrations of IL-6 and cortisol were observed following TRT prednisone. The estimated peak value of IL-6 fell from 42.2 to 21.3 pg/ml and occurred earlier (8:05 am compared with 1:21 am; p < 0.005). Following TRT prednisone, the peak value of cortisol increased from 14.1 to 19.3 mug/dl and the trough fell from 2.9 to 2.1 |jg/dl (p < 0.001). Clinical symptoms, particularly morning stiffness (p = 0.028), were reduced, but in three patients with high concentrations of IL-1 receptor antagonist, IL-1p, IL-4 and TNF, neither IL-6 nor morning stiffness changed. Conclusion: Prednisone released at 2 am does suppress the pathological early-morning rise in plasma IL-6 in RA. The nocturnal rise in plasma cortisol was not suppressed but was enhanced, consist...
机译：目的：夜间（凌晨2点）给药可增强泼尼松对类风湿关节炎（RA）早晨关节僵硬的影响。假设这可能是由于抑制了血浆IL-6的病理性早起上升，但尚未对此进行测量。夜间泼尼松的理论上的缺点是对下丘脑-垂体-肾上腺轴的抑制作用增强，血浆皮质醇水平降低，通常在上午7点左右达到。这项研究测量了夜间泼尼松2周疗程前后的患者中IL-6，其他细胞因子和皮质醇的24小时变化，以解决这两个问题。材料与方法：对9名活动性RA患者进行了临床评估，并在2周疗程的定时释放片剂（TRT）泼尼松（每天5 mg）之前和之后进行了24小时血液采样。患者在晚上10点口服TRT，泼尼松在凌晨2点被释放。使用回归模型和Wilcoxon配对配对符号秩检验比较皮质醇和IL-6昼夜节律变化的变化以及临床措施。还测量了细胞因子IL-1受体拮抗剂，IL-1p，IL-4和TNF。结果：TRT泼尼松后，其昼夜节律和IL-6和皮质醇浓度发生了显着变化。 IL-6的估计峰值从42.2 pg / ml下降到21.3 pg / ml，并且发生得更早（上午8:05，上午1：21; p <0.005）。在TRT泼尼松后，皮质醇的峰值从14.1马克/分升增加到19.3马克/分升，波谷从2.9微克/分升降低到2.1微克/分升（p <0.001）。临床症状，特别是早晨僵硬（p = 0.028）有所减轻，但是在三例高浓度IL-1受体拮抗剂，IL-1p，IL-4和TNF的患者中，IL-6和早晨僵硬都没有改变。结论：泼尼松在凌晨2点释放确实抑制了RA中血浆IL-6的病理性早起上升。血浆皮质醇的夜间升高并未受到抑制，但增强了，包括...

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