title: Humor in systemic lupus erythematosus.
abstract: OBJECTIVE
  Humor has neurophysiological effects influencing the release of cortisol, which may have a direct impact on the immune system. Laughter is associated with a decreased production of inflammatory cytokines both in the general population and in rheumatoid arthritis (RA). Our objective was to explore the effects of humor on serum cytokines [particularly interleukin-6 (IL-6)] and cortisol levels in systemic lupus erythematosus (SLE), after a standard intervention (120 min of visual comedy).
  
  
  METHODS
  We enrolled 58 females with SLE from consecutive patients assessed in the Montreal General Hospital lupus clinic. The subjects who consented to participate were randomized in a 1:1 ratio to the intervention (watching 120 min of comedy) or control group (watching a 120 min documentary). Measurements of cytokine and serum cortisol levels as well as 24-h urine cortisol were taken before, during, and after the interventions. We compared serum cytokine levels and serum and 24-h urine cortisol levels in the humor and control groups and performed regression analyses of these outcomes, adjusting for demographics and the current use of prednisone.
  
  
  RESULTS
  There were no significant differences between the control and humor groups in demographics or clinical variables. Baseline serum levels of IL-6, IL-10, tumor necrosis factor-alpha, and B-cell activating factor were also similar in both groups. There was no evidence of a humor effect in terms of decreasing cytokine levels, although there was some suggestion of lowered cortisol secretion in the humor group based the 24-h urinary cortisol levels in a subgroup.
  
  
  CONCLUSIONS
  In contrast to what has been published for RA, we saw no clear effects of humor in altering cytokine levels in SLE, although interesting trends were seen for lower cortisol levels after humor intervention compared with the control group.
authors.affiliation: Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Cristiano S
authors.initials: CS
authors.lastname: Moura
authors.affiliation: Department of Neuroimmunology, Montreal Neurological Institute, McGill University Faculty of Medicine, Quebec, Canada.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Neuroimmunology, Montreal Neurological Institute, McGill University Faculty of Medicine, Quebec, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lawrie
authors.affiliation: Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.affiliation: Department of Rheumatology, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Clarke
authors.affiliation: Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Da Costa
authors.affiliation: Department of Allergy and Clinical Immunology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Devi
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Department of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Pineau
keywords: Epidemiology; cytokine; humor; rheumatoid arthritis; systemic lupus erythematosus