anti-inflammatory cytokine. It is secreted by T cells and macrophages
to stimulate immune response, e.g. during infection and after trauma.
IL-6 is relevant to many disease processes such as diabetes,
atherosclerosis, Alzheimer's Disease, systemic lupus erythematosus,
depression and rheumatoid arthritis for example. The glucorticoid
receptor (GR) is expressed in almost every cell in the body and
regulates genes controlling the development, metabolism, and immune
response.
Although pain pressure measurement at tender points is de-emphasized
in favor of patient checklists in the new fibromyalgia definition, it
does allow for objective measurement in subgroups.
Psychoneuroendocrinology. 2011 Oct 13. [Epub ahead of print]
Evidence for an association between an enhanced reactivity of
interleukin-6 levels and reduced glucocorticoid sensitivity in
patients with fibromyalgia.
Geiss A, Rohleder N, Anton F.
Department of Psychobiology, University of Trier, D-54290 Trier,
Germany; University of Cologne, D-50931 K=F6ln, Germany.
Abstract
Pain and fatigue have been identified as core symptoms of fibromyalgia
syndrome (FMS). Since both symptoms are also characteristic of
hypocortisolemic disorders, reduced cortisol levels have been thought
to promote an exacerbation of these FMS core symptoms by an enhanced
reactivity of interleukin-6 (IL-6) levels.
The aim of the current study was to investigate the pathophysiologic
relevance of reduced cortisol levels for manifestation of FMS core
symptoms.
Twelve female FMS patients with 15 female controls were compared
regarding the function of hypothalamus-pituitary-adrenal (HPA) axis
and behavioral, endocrine and IL-6 responses after measuring the
pressure pain thresholds (PPTs) at tender points. Function of HPA axis
was assessed by determining the cortisol awakening response, daytime
profile of cortisol secretion, low dose overnight dexamethasone
suppression test (DST) and glucocorticoid sensitivity (GC) of
inflammatory cytokine production.
While endocrine and IL-6 responses were determined by collecting blood
and saliva samples behavioral responses were assessed by pain and
fatigue recordings of participants before and after PPT measurement
using visual analogue scale (VAS). Whereas FMS patients were found not
to differ from controls in cortisol awakening response, daytime
profile of cortisol secretion and cortisol suppression after overnight
DST, they did exhibit a reduced GC sensitivity of inflammatory
cytokine production.
PPT measurement did induce three times higher cortisol and four times
higher IL-6 levels in FMS patients, but no change in their ACTH
levels. The enhanced IL-6 reactivity after PPT measurement was
accompanied by an increase in the severity of FMS patients' pain and
fatigue ratings. The findings of the present study provide evidence
for the pathophysiologic relevance of a disturbed glucocorticoid
receptor (GR) function, rather than reduced cortisol levels for the
maintenance of FMS core symptoms.
Copyright =A9 2011 Elsevier Ltd. All rights reserved.
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