Diurnal courses of cortisol, pain, fatigue, negative mood, and stiffness in patients with recently diagnosed rheumatoid arthritis

International Journal of Behavioral Medicine (Impact Factor: 2.63). 04/2012; 7(4):353-371. DOI: 10.1207/S15327558IJBM0704_06

ABSTRACT To investigate the diurnal courses of cortisol and the daytime states: pain, fatigue, negative mood, and stiffness of patients
with rheumatoid arthritis, as well as the association between the cortisol and state courses, 9 repeated measurementson 2consecutive
days were taken in the real-life environment of 25 recently diagnosed patients (19 women, 6 men; mean age 55.2 years) and
28 healthy controls (20 women, 8 men; mean age 55.8 years). Patients showed a highly characteristic diurnal course of cortisol
(F8, 15 = 7.4, p < .001) and a significant diurnal fatigue (F7, 18 = 2.6, p < .05) and early morning stiffness course (F3, 22 = 6.2, p < .01), but the temporal association between these courses was low. Daytime states, notably fatigue (r = 0.40, p
< .05), were positively correlated with the early morning rise of cortisol and nighttime pain (r ≥ 0.53, p < .01) but not
with cortisol level or inflammatory activity. Cortisol level and inflammatory activity were positively correlated (r = 0.47,
p < .05). These results suggest that in patients with rheumatoid arthritis, cortisol has a strong endogenous rhythm that is
not disturbed by inflammatory activity. It appears that diurnal fluctuations in fatigue and stiffness are independent of the
circadian rhythm of cortisol or inflammatory activity, but rather reflect temporal changes as a consequence of sleep, rest,
and physical activity throughout the day.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We measured affect in 334 healthy adults on each of 7 days over a 3-week period. On the last day, salivary cortisol was assessed 14 times yielding scores for total concentration, morning rise amplitude, and slope of the time function. Trait negative affect (NA) was associated with higher total cortisol concentrations and greater morning rise in men. Cortisol levels for men low in trait positive affect (PA) did not decrease in the afternoon, resulting in a relatively high, flat rhythm. In contrast, women high in trait PA had low morning cortisol resulting in a low flat rhythm. State (person-centered) NA was not associated with same-day cortisol measures. State PA was associated with decreased total cortisol concentration in women. These are the first results showing associations between cortisol and trait PA. Differences in rhythmicity found here are noteworthy given the possible role of cortisol dysregulation in disease incidence, morbidity, mortality, and severity.
    Psychoneuroendocrinology 04/2005; 30(3):261-72. · 5.59 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fatigue and pain are important symptoms for patients with rheumatoid arthritis (RA), but their temporal association is unknown. Therefore, the objective of this study was to investigate the longitudinal relationship between fatigue and pain in patients with RA using time-lag models. Consecutive RA outpatients (n = 228) were enrolled for this 1-year study. Fatigue was assessed monthly with the Checklist Individual Strength (CIS; range 8-56) and pain was assessed monthly with the bodily pain subscale (inverted, range 0-100) of the Short Form 36. The association between monthly changes in fatigue and pain was analyzed using longitudinal regression (mixed models), using the same months and with a 1-month time lag. A total of 198 patients were included in the analyses. At baseline, the mean ± SD pain score was 35.23 ± 19.82 and the mean ± SD CIS fatigue score was 31.0 ± 12.4. Severe fatigue at baseline (CIS score ≥35) was present in 42% of the patients. The mean ± SD patient-averaged CIS fatigue score over 1 year was 30.9 ± 6.0 and the mean ± SD patient-averaged pain score over 1 year was 36.4 ± 18.3. The longitudinal regression analysis showed a significant positive relationship between fatigue and pain during the same month (β = 2.04; 95% confidence interval 1.82, 2.27). The models using a time lag showed no significant association between changes in pain and changes in fatigue. In established RA, pain and fatigue show monthly fluctuations that are synchronous rather than showing a temporal relationship with a time lag; within this timeframe, the results do not indicate that one precedes the other.
    Arthritis care & research. 06/2013; 65(6):862-9.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The hypothalamic-pituitary-adrenal (HPA) axis is a psychoneuroendocrine regulator of the stress response and immune system, and dysfunctions have been associated with outcomes in several physical health conditions. Its end product, cortisol, is relevant to fatigue due to its role in energy metabolism. The systematic review examined the relationship between different markers of unstimulated salivary cortisol activity in everyday life in chronic fatigue syndrome (CFS) and fatigue assessed in other clinical and general populations. Search terms for the review related to salivary cortisol assessments, everyday life contexts, and fatigue. All eligible studies (n=19) were reviewed narratively in terms of associations between fatigue and assessed cortisol markers, including the cortisol awakening response (CAR), circadian profile (CP) output, and diurnal cortisol slope (DCS). Subset meta-analyses were conducted of case-control CFS studies examining group differences in three cortisol outcomes: CAR output; CAR increase; and CP output. Meta-analyses revealed an attenuation of the CAR increase within CFS compared to controls (d=-.34) but no statistically significant differences between groups for other markers. In the narrative review, total cortisol output (CAR or CP) was rarely associated with fatigue in any population; CAR increase and DCS were most relevant. Outcomes reflecting within-day change in cortisol levels (CAR increase; DCS) may be the most relevant to fatigue experience, and future research in this area should report at least one such marker. Results should be considered with caution due to heterogeneity in one meta-analysis and the small number of studies.
    Psychoneuroendocrinology 08/2013; · 5.59 Impact Factor