University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK.
Ann N Y Acad Sci. 2010 Apr;1193:127-33. doi: 10.1111/j.1749-6632.2009.05289.x.
The morning stiffness and pain of rheumatoid arthritis (RA) is accompanied by a rise in serum interleukin-6 (IL-6) from 2 am to 7 am. Using a formulation that releases prednisone at 2 am (after ingestion at 10 pm), we studied the circadian dynamics of serum IL-6, other cytokines, and cortisol in 9 patients before and after 2 weeks, therapy. Significant improvements occurred in morning stiffness, pain, disease activity, and the acute-phase response. Only IL-6 showed measurable cytokine circadian variation, its high pretreatment peak was abolished, and changes in IL-6 correlated with the changes in morning stiffness. Following treatment, afternoon and evening serum cortisol was reduced, but in the early morning cortisol peak concentration increased. Thus the severity of morning symptoms is related to nocturnal serum IL-6 concentration. The specific timing of the medication, linked to the interaction between IL-6 and the hypothalamic-pituitary-adrenal (HPA) axis, may correct a postulated deficiency in HPA control in RA.
类风湿关节炎（RA）的晨僵和疼痛伴随着血清白细胞介素-6（IL-6）水平从凌晨 2 点到 7 点的升高。我们使用一种在凌晨 2 点（晚上 10 点服用后）释放泼尼松的配方，在 2 周治疗前后研究了 9 例患者的血清 IL-6、其他细胞因子和皮质醇的昼夜动态变化。晨僵、疼痛、疾病活动度和急性期反应均有显著改善。只有 IL-6 表现出可测量的细胞因子昼夜变化，其高预处理峰值被消除，并且 IL-6 的变化与晨僵的变化相关。治疗后，下午和晚上的血清皮质醇降低，但清晨皮质醇峰值浓度增加。因此，晨症的严重程度与夜间血清 IL-6 浓度有关。药物的特定时间，与 IL-6 和下丘脑-垂体-肾上腺（HPA）轴之间的相互作用有关，可能纠正 RA 中 HPA 控制的假设缺陷。
