Extended reports
The timing of glucocorticoid administration in rheumatoid
arthritis
a University Hospital Uppsala,
Sweden: Section of Rheumatology, Department of
Internal Medicine , b Department of Clinical Chemistry
Correspondence to: Nils Gunnar Arvidson MD, Section of Rheumatology, Department of Internal Medicine, Uppsala University Hospital, S-751 85 Uppsala, Sweden.
Accepted for publication 25 October 1996
OBJECTIVE
To test the hypothesis that the timing
of prednisolone administration might be critical in determining its
effect on the diurnal rheumatoid inflammatory process.
METHODS26 patients with rheumatoid arthritis
were randomly divided into two equal groups and allocated to low doses
of prednisolone at either 2.00 am or 7.30 am. Because of the diurnal
variation in disease activity in rheumatoid arthritis, assessments of
the two study groups were performed at 7.30 am both at the start of the
study (day 1) and after four doses of prednisolone (day 5). The study
protocol differences in the time period from the last dose of
prednisolone to assessment were 5.5 hours in the 2.00 am group and 24 hours in the 7.30 am group.
RESULTSAdministration of low doses of
prednisolone (5 or 7.5 mg daily) at 2.00 am had favourable effects on
the duration of morning stiffness (P << 0.001), joint pain (P < 0.001), Lansbury index (P << 0.001), Ritchie index (P << 0.001),
and morning serum concentrations of IL-6 (P < 0.01). The other study
group showed minor but significant effects on morning stiffness (P < 0.05) and circulating concentrations of IL-6 (P < 0.05). Modest and
similar improvements of C reactive protein, serum amyloid protein A,
and erythrocyte sedimentation rate were seen in both study groups.
CONCLUSIONSAdministration of low doses of
glucocorticoids with a rather short biological half life seems to
improve acute rheumatoid arthritis symptoms if it precedes the period
of circadian flare in inflammatory activity, as defined by enhanced
IL-6 synthesis. Further studies are needed to test the relative merits
of different timing protocols of glucocorticoid administration in
rheumatoid arthritis.
© 1997 by Annals of the Rheumatic Diseases
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