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. 1997 Jan;56(1):1–4. doi: 10.1136/ard.56.1.1

Dilemmas of low dosage glucocorticoid treatment in rheumatoid arthritis: considerations of timing

A MASI 1, G CHROUSOS 1
PMCID: PMC1752247  PMID: 9059132

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A heuristic scheme showing the circadian rhythmicity of plasma ACTH (upper panel), cortisol (middle panel), and interleukin-6 (IL-6) (lower panel) in normal controls (solid lines) and early, untreated patients with rheumatoid arthritis (interrupted lines). Note the early (phase advanced) circadian peaks of ACTH and cortisol in the patients, who have a later (phase delayed) marked peak elevation in their circadian plasma IL-6. The latter cytokine is a potent stimulator of the hypothalamic-pituitary-adrenal axis, which probably drives the phase advanced plasma ACTH and cortisol circadian peaks in the rheumatoid arthritis patients. Paradoxically, the mean plasma ACTH and cortisol concentrations over 24 h are not raised in the patients.15

Selected References

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