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. 2003 Jul;62(7):593–596. doi: 10.1136/ard.62.7.593

Circadian rhythms in RA

M Cutolo 1, B Seriolo 1, C Craviotto 1, C Pizzorni 1, A Sulli 1
PMCID: PMC1754587  PMID: 12810417

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Figure 1.

Figure 1

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Clinical signs and symptoms of articular inflammation in patients with RA change consistently as a function of the hours of the day: pain and joint stiffness are greater after waking up in the morning than in the afternoon or evening.

Figure 2.

Figure 2

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A diurnal rhythmicity in healthy humans between cellular (Th1 type) or humoral (Th2 type) immune responses has been found and related to the immunomodulatory effects exerted by cortisol and melatonin, respectively.

Figure 3.

Figure 3

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A lower than expected cortisol secretion as seen during testing in patients with RA, should be clearly regarded as a "relative adrenal insufficiency" in the setting of a sustained inflammatory process (that is, high IL6 serum levels).

Figure 4.

Figure 4

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IFNγ, IL2, as well as IL1, IL6, IL12, and TNFα production (Th1 cytokines) reach a peak during the night and early morning, when MLT serum levels are highest and plasma cortisol levels the lowest. Therefore, MLT may be implicated in a more active inflammatory response during the night, and the clinical symptoms follow this rhythm in patients with RA.

Selected References

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