The timing of glucocorticoid administration in rheumatoid arthritis
The timing of glucocorticoid administration in rheumatoid arthritis
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DOI：
10.1136/ard.56.1.27
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发表时间：
1997-01-01
影响因子：
27.4
通讯作者：
Hallgren, R
中科院分区：
文献类型：
--
作者：
Arvidson, NG;Gudbjornsson, B;Hallgren, R
目的：验证强的松龙给药时机对类风湿关节炎患者的影响的假设。方法26例类风湿关节炎患者随机分为两组，分别在凌晨2：00或7：30给予小剂量强的松龙治疗。由于类风湿性关节炎疾病活动的日变化，两个研究组在研究开始(第1天)和服用4剂强的松龙(第5天)后的上午7：30进行了评估。结果：凌晨2点给予小剂量强的松龙(每天5 mg或7.5 mg)对晨僵持续时间(P<0.001)、关节疼痛(P<；0.001)、兰斯伯里指数(P<0.001)、里奇指数(P<0.001)和晨血IL-6浓度(P<；；0.01)。另一研究组对晨僵(P<；0.05)和循环中IL-6浓度(P<；0.05)有轻微但显著的影响。两组患者在C反应蛋白、血清淀粉样蛋白A和血沉方面均有轻微和相似的改善。结论：如果在炎症活动昼夜节律期之前给予生物半衰期相当短的小剂量糖皮质激素，似乎可以改善急性类风湿性关节炎的症状，这是由IL-6合成增强所定义的。需要进一步的研究来测试糖皮质激素治疗类风湿性关节炎不同计时方案的相对优劣。
Objective-To test the hypothesis that the timing of prednisolone administration might be critical in determining its effect on the diurnal rheumatoid inflammatory process.Methods-26 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.Results-Administration 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 much less than 0.001), joint pain (P < 0.001), Lansbury index (P much less than 0.001), Ritchie index (P much less than 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.Conclusions-Administration 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.