RESEARCH - Acute cold stress in RA inadequately activates stress responses and induces an increase of IL-6

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Ann Rheum Dis. Published Online First: 15 April 2008.

doi:10.1136/ard.2008.089458

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Extended Report

Acute cold stress in rheumatoid arthritis inadequately activates

stress responses and induces an increase of interleukin-6

Rainer H Straub 1*, Georg Pongratz 1, Hanna Hirvonen 2, Timo

Pohjolainen 3, Marja Mikkelsson 2 and Marjatta Leirisalo-Repo 4

1 University Hospital Regensburg, Germany

2 Rheumatism Foundation Hospital, Heinola, Finland

3 Orton, the Rehabilitation Unit of the Invalid Foundation, Helsinki, Finland

4 Helsinki University Central Hospital, Finland

Abstract

Objective: Acute stress in patients with rheumatoid arthritis (RA)

should stimulate a strong stress response. After cryotherapy, we

expected an increase of hormones of the adrenal gland and the

sympathetic nervous system.

Methods: Fifty-five patients with RA were recruited for whole-body

cryotherapy at 110°C and 60°C, and local cold therapy between -20°C

and -30°C for 7d. We measured plasma levels of steroid hormones,

neuropeptide Y (sympathetic marker), and IL-6 daily before and after

cryotherapy.

Results: In both therapy groups with/without glucocorticoids (GC),

hormone and IL-6 levels at baseline and 5hr after cold stress did not

change during 7d of cryotherapy. In patients without GC, plasma levels

of cortisol and androstenedione were highest after -110°C cold stress

followed by 60°C or local cold stress. This was opposite in patients

under GC therapy, in whom unexpectedly -110°C cold stress elicited the

smallest responses. In patients without GC, adrenal cortisol

production increased relative to other adrenal steroids, which was

again opposite under GC therapy with a loss of cortisol and an

increase of DHEA. Importantly, there was no sympathetic stress

response in both groups. Patients without GC and 110°C cold stress

demonstrated higher plasma IL-6 compared to the other treatment groups

(not observed under GC), but they showed the best clinical response.

Conclusions: We detected an inadequate stress response in patients

with GC. It is further shown that the sympathetic stress response was

inadequate in patients with/without GC. Paradoxically, plasma levels

of IL-6 increased under strong cold stress in patients without GC.

These findings confirm dysfunctional stress axes in RA.

http://ard.bmj.com/cgi/content/abstract/ard.2008.089458v1?papetoc

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