Abstract
Aim: The effect of prednisone on the morning joint stiffness of rheumatoid arthritis (RA) is enhanced by night-time (2 am) administration. It has been hypothesized that this may be due to suppression of the pathological early-morning rise in plasma IL-6, but this has not yet been measured. A theoretical disadvantage of night-time prednisone is increased suppression of the hypothalamic–pituitary–adrenal axis and reduced peak plasma cortisol levels, usually attained at approximately 7 am. This study measured 24-h variations in IL-6, other cytokines and cortisol in patients before and after a 2-week course of night-time prednisone to address both these questions. Materials & methods: Nine patients with active RA were clinically assessed and had 24-h blood sampling before and after a 2-week course of timed-release tablet (TRT) prednisone (5 mg per day). Patients took the TRT orally at 10 pm and the prednisone was released at 2 am. Changes in circadian variation in cortisol and IL-6 and clinical measures were ...
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