2017
DOI: 10.5114/reum.2017.69779 View full text |Buy / Rent full text
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Abstract: Morning symptoms of rheumatoid arthritis (RA) are linked to circadian increase of night inflammation, supported by inadequate cortisol secretion in active disease. Therefore, exogenous glucocorticoid administration in RA is recommended by EULAR and ACR from the beginning of the diagnosis, since may partially act like a “replacement therapy”. In addition, the prevention/treatment of the night up-regulation of the immune/inflammatory reaction has been shown more effective when exogenous glucocorticoid administra… Show more

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“…We now show that dexamethasone drives CXCR4 expression in Tregs, implicating activation of the glucocorticoid receptor as sufficient to impart a circadian signal. Whilst acute inflammatory events activate the HPA axis and enhance glucocorticoid secretion, this does not occur in inflammatory arthritis 51 . Instead, the amplitude and period of serum cortisol levels are similar to healthy controls 52 .…”
Section: Discussionmentioning
“…Further studies must examine the underlying mechanisms for an effect of corticosteroid in women with RA. In our study, corticosteroid could be prescribed for a number of reasons, including (1) the Danish fertility doctors are familiar with the theory of a possible positive role of corticosteroids in terms of an improved chance of implantation in relation to ART and/or (2) patients with RA could receive corticosteroids because it is a well-known treatment for RA,28 29 and because they constitute an important part of supplementary treatment to control of disease activity 30 31. In our data, the underlying reason for prescribing corticosteroids cannot be established.…”
Section: Discussionmentioning
“…Nevertheless, biological sleep and consolidated circa-dian rhythms are essential for health, and a greater effort to communicate scientific findings to the general public and the medical community is urgently needed. Ultimately, societies may or may not be prepared to make changes in, for example, how hospitals are run or the adoption of time-release drug preparations that are more expensive in the short term but confer superior medical and economic utility in the long term (146). Regardless of these meta-issues, small innovations can yield significant benefits.…”
Section: Challengesmentioning
“…Inflammation is the basis of RA development; therefore, it is an important target for RA therapy [3]. It has been proven that clinical agents targeting inflammatory mediators or various cytokines, such as antibody drugs (adalimumab and anakinra) which interfere with the progression of inflammation [4] and glucocorticoid drugs which inhibit cellular and humoral immunity [5], could prevent RA. Chemical drug treatment, alone or in combination, although can take significant effect in short term, is easy to illness relapses and side effects on patients.…”
Section: Introductionmentioning
“…48 Related to nightly activation of the inflammatory response, administration of exogenous GCs in midnight has evolved as "chronotherapy". 49 In a double-blind randomized controlled trial (RCT), low-dose prednisone with modified release added to the ongoing DMARD treatment was shown to induce a significant effect on disease activity and health-related quality of life compared to placebo. 50 In relation with chronotherapy, new formulations of GCs including modified or delayed-release prednisone are arising.…”
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