Overnight variations in cortisol, interleukin 6, tumour necrosis factor α and other cytokines in people with rheumatoid arthritis
2009

Overnight Changes in Cytokines and Cortisol in Rheumatoid Arthritis

Sample size: 16 publication 10 minutes Evidence: moderate

Author Information

Author(s): Perry M G, Kirwan J R, Jessop D S, Hunt L P

Primary Institution: University of Bristol

Hypothesis

To investigate overnight variations in absolute values and patterns of cytokines including interleukin 6 (IL6) and tumour necrosis factor α (TNFα) in rheumatoid arthritis (RA), and to relate any changes to those occurring in blood cortisol.

Conclusion

The mean IL6 and cortisol concentrations showed a significant overnight variation, with IL6 rising approximately 3 hours before cortisol.

Supporting Evidence

  • IL6 concentration rose significantly from 35 pg/ml at 22:00 to 64 pg/ml at 07:15.
  • Cortisol concentration rose significantly overnight from 57 ng/ml at 01:00 to 229 ng/ml at 07:15.
  • IL6 began to rise approximately 3 hours before cortisol in most participants.

Takeaway

People with rheumatoid arthritis have higher levels of a substance called IL6 in the morning, which happens before their cortisol levels rise.

Methodology

Blood samples were obtained at 13 time points overnight from 16 patients with active RA.

Potential Biases

Potential bias from the use of an intravenous cannula which may affect cytokine levels.

Limitations

The study had a relatively small sample size and was only conducted overnight, not over a full 24-hour period.

Participant Demographics

8 men and 8 women, mean age 59 years, mean disease duration 10 years.

Statistical Information

P-Value

p<0.001

Confidence Interval

95% CI for IL6: 34.5 pg/ml to 64.4 pg/ml; for cortisol: 56.9 ng/ml to 228.7 ng/ml.

Statistical Significance

p<0.001

Digital Object Identifier (DOI)

10.1136/ard.2007.086561

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