Neeck G, Federlin K, Graef V, Rusch D, Schmidt K L
Z Rheumatol. 1987 Mar-Apr;46(2):53-8.
In patients with rheumatoid arthritis, corticosteroids are usually given as a single morning dose to minimize adrenal suppression, because of the well-known circadian rhythm of the secretion of cortisol and corticotropin. However, it has not been so far examined whether there really is a normal secretion pattern of those hormones in all patients with rheumatoid arthritis, as there is in healthy subjects. We therefore studied twelve patients with rheumatoid arthritis who had never been treated before with corticosteroids and disease-modifying drugs such as gold, D-penicillamine or immunosuppressive drugs. The study was designed to examine adrenal secretory activity by measuring the cortisol and corticotropin levels at 2 h intervals throughout a 24 h cycle. The circadian secretion patterns of cortisol and corticotropin were disturbed in most patients. High inflammatory activity of the disease was accompanied by a severe disturbance of the circadian rhythm, whereas patients with low inflammatory activity showed a nearly normal secretion pattern. Besides other causes, the influence of mediators of inflammation on hypothalamic centers, analogous to endogenous pyrogen in fever, must be discussed.
在类风湿性关节炎患者中，由于众所周知的皮质醇和促肾上腺皮质激素分泌的昼夜节律，通常在早晨单次给药皮质类固醇，以尽量减少肾上腺抑制。然而，到目前为止，尚未研究所有类风湿性关节炎患者中这些激素是否真的存在像健康受试者那样的正常分泌模式。因此，我们研究了12名从未接受过皮质类固醇和金、D-青霉胺或免疫抑制药物等改善病情药物治疗的类风湿性关节炎患者。该研究旨在通过在24小时周期内每隔2小时测量皮质醇和促肾上腺皮质激素水平来检查肾上腺分泌活动。大多数患者的皮质醇和促肾上腺皮质激素的昼夜分泌模式受到干扰。疾病的高炎症活动伴随着昼夜节律的严重紊乱，而炎症活动低的患者表现出几乎正常的分泌模式。除其他原因外，必须讨论炎症介质对下丘脑中枢的影响，类似于发热时的内源性致热原。
