Serum cytokines and steroidal hormones in polymyalgia rheumatica and elderly-onset rheumatoid arthritis.
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).


OBJECTIVE
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).


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 alpha (TNFalpha), interleukin (IL)6, IL1 receptor antagonist (IL1Ra), cortisol, dehydroepiandrosterone sulphate (DHEAS) and 17-hydroxy-progesterone (PRG) were evaluated.


RESULTS
Serum levels of both TNFalpha 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 TNFalpha 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.
Cutolo
M
M
Department of Internal Medicine, Research Laboratory and Division of Rheumatology, University Hospital San Martino, Viale Benedetto XV no 6, 16132 Genova, Italy. mcutolo@unige.it
Montecucco
C M
CM
Cavagna
L
L
Caporali
R
R
Capellino
S
S
Montagna
P
P
Fazzuoli
L
L
Villaggio
B
B
Seriolo
B
B
Sulli
A
A
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D016207:Cytokines / Q000097:blood*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000097:blood* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D006728:Hormones; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone; D002097:C-Reactive Protein; D011241:Prednisone; D006854:Hydrocortisone