title: The timing of glucocorticoid administration in rheumatoid arthritis.
abstract: 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 < < 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.
  
  
  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.
authors.affiliation: Department of Internal Medicine, University Hospital, Uppsala, Sweden.
authors.forename: N G
authors.initials: NG
authors.lastname: Arvidson
authors.forename: B
authors.initials: B
authors.lastname: Gudbjörnsson
authors.forename: A
authors.initials: A
authors.lastname: Larsson
authors.forename: R
authors.initials: R
authors.lastname: Hällgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D002940:Circadian Rhythm; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D000685:Serum Amyloid A Protein / Q000378:metabolism
chemical_list: D015850:Interleukin-6; C094771:SAA4 protein, human; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D011239:Prednisolone