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The timing of glucocorticoid administration in rheumatoid arthritis
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
1997 In: Annals of the Rheumatic Diseases, Vol. 56, 27-31 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
1997. Vol. 56, 27-31 p.
Identifiers
URN: urn:nbn:se:uu:diva-90247OAI: oai:DiVA.org:uu-90247DiVA: diva2:162539
Available from: 2003-04-25 Created: 2003-04-25Bibliographically approved
In thesis
1. Disease activity in rheumatoid arthritis: Studies in interleukin-6, tumour necrosis factor alpha, monocyte activity, acute phase markers, glucocorticoids, and disability
Open this publication in new window or tab >>Disease activity in rheumatoid arthritis: Studies in interleukin-6, tumour necrosis factor alpha, monocyte activity, acute phase markers, glucocorticoids, and disability
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the present studies, aspects of some disease activity measures in rheumatoid arthritis (RA) have been investigated, including the effect of glucocorticoids on this activity. In RA, serum interleukin(IL)-6 levels were elevated and were shown to have a circadian rhythm, with peak levels in the morning, declining towards low or normal levels in the afternoon and evening. In contrast, serum levels of tumour necrosis factor(TNF) alpha were low and stable. In other connective tissue diseases, serum TNF alpha levels were elevated but without circadian variation, while IL-6 levels were low and stable. Nocturnal administration (at 2:00 a.m.) of low-dose prednisolone a few hours before the early morning peak of IL-6 was shown to be significantly more effective in reducing clinical symptoms of disease activity and serum IL-6 levels than the traditional morning administration (at 7:30 a.m.) of the same dose of prednisolone. Circulating monocytes are activated in RA, expressing receptors related to adhesion and phagocytosis. Treatment with glucocorticoids suppressed the expression of these receptors on monocytes, and this may be one mechanism of the beneficial effect of glucocorticoids in RA. Endogenous levels of cortisol seem to play a minor role in expression of monocyte receptors. The different acute phase markers used to assess disease activity in RA showed good corrrelations with each other and with serum IL-6 levels. There were especially strong corrrelations between C-reactive protein (CRP) and Serum amyloid protein A (SAA), and between fibrinogen and erythrocyte sedimentation rate (ESR). Fibrinogen and CRP showed stronger correlation than ESR with the Modified Health Assessment Questionnaire (MHAQ) score and with the neutrophil count. Four simple objective function tests were each compared with the HAQ score a with a radiological joint damage score (Larsen score). The objective function tests correlated with the MHAQ score, and each of these two methods of assessing physical disability correlated with pain, CRP and ESR. In addition, most of the objective function tests correlated significantly with radiological joint damage, while the MHAQ score did not.

Place, publisher, year, edition, pages
Uppsala: Institutionen för medicinska vetenskaper, 2003. 91 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1248
Keyword
Chemistry, acute phase markers, circadian rhythm, disability, disease activity, glucocorticoids, monocyte activation, rheumatoid arthritis, Kemi
National Category
Chemical Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-3373 (URN)91-554-5594-8 (ISBN)
Public defence
2003-05-19, Rosénsalen, Barnkliniken, Uppsala, 13:15
Opponent
Supervisors
Available from: 2003-04-25 Created: 2003-04-25Bibliographically approved

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