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Serum cytokines and steroidal hormones in polymyalgia rheumatica and elderly-onset rheumatoid arthritis
  1. M Cutolo1,
  2. C M Montecucco2,
  3. L Cavagna2,
  4. R Caporali2,
  5. S Capellino1,
  6. P Montagna1,
  7. L Fazzuoli3,
  8. B Villaggio4,
  9. B Seriolo1,
  10. A Sulli1
  1. 1Department of Internal Medicine, Research Laboratory and Division of Rheumatology, San Martino Hospital, University of Genova, Genova, Italy
  2. 2Division of Rheumatology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
  3. 3Laboratory of Endocrinology, Department of Endocrinology and Metabolism, University of Genova, Genova, Italy
  4. 4Laboratory of Nephrology, Department of Internal Medicine, San Martino Hospital, University of Genova, Genova, Italy
  1. Correspondence to:
    M Cutolo
    Department of Internal Medicine, Research Laboratory and Division of Rheumatology, University Hospital San Martino, Viale Benedetto XV no 6, 16132 Genova, Italy; mcutolo{at}


Background: Polymyalgia rheumatica (PMR) may create some difficulties in the differential diagnosis of elderly-onset rheumatoid arthritis (EORA) and of EORA with PMR-like onset (EORA/PMR).

Aim: To investigate possible differences between three groups of patients, with regard to serum levels of inflammatory cytokines and steroidal hormones at baseline and after 1 month of treatment with glucocorticoids (prednisone 7.5–12.5 mg/day).

Patients and methods: 14 patients with PMR, 15 with EORA and 14 with EORA/PMR, as well as 15 healthy, matched controls were analysed. Tumour necrosis factor α (TNFα), interleukin (IL)6, IL1 receptor antagonist (IL1Ra), cortisol, dehydroepiandrosterone sulphate (DHEAS) and 17-hydroxy-progesterone (PRG) were evaluated.

Results: Serum levels of both TNFα and IL6 were significantly higher in all three groups of patients than in controls (p<0.01). Serum IL6 levels were significantly higher in patients with both PMR and EORA/PMR than in patients with EORA (p<0.05). IL1Ra serum levels were significantly higher in patients with EORA than in controls (p<0.001) and in patients with PMR and EORA/PMR (p<0.05). DHEAS was significantly lower in patients with EORA/PMR than in those with EORA (p<0.05). PRG was significantly higher in all patient groups (p<0.05). After glucocorticoid treatment, serum TNFα and IL6 levels significantly decreased in all patient groups; IL1Ra significantly increased in patients with PMR and in those with EORA/PMR; cortisol, DHEAS, and PRG significantly decreased in patients with PMR and in those with EORA/PMR (p<0.05).

Conclusions: Different cytokine and steroidal hormone patterns suggest that patients with PMR and those with EORA/PMR seem to be have a more intensive inflammatory reaction and are more efficient responders to glucocorticoid treatment than patients with EORA.

  • ACTH, adrenocorticotrophic hormone
  • CRP, C reactive protein
  • DHEAS, dehydroepiandrosterone sulphate
  • EORA, elderly-onset rheumatoid arthritis
  • EORA/PMR, EORA with polymyalgia rheumatica-like onset
  • ESR, erythrocyte sedimentation rate
  • IL1Ra, interleukin 1 receptor antagonist
  • PMR, polymyalgia rheumatica
  • PRG, 17-hydroxy-progesterone
  • TNFα, tumour necrosis factor α

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  • Published Online First 2 June 2006

  • Competing interests: None declared.

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