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

Division of Clinical and Health Psychology, Utrecht University, Utrecht, Utrecht, Netherlands
International Journal of Behavioral Medicine (Impact Factor: 2.63). 04/2012; 7(4):353-371. DOI: 10.1207/S15327558IJBM0704_06


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.

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    • "Following standard practices (e.g. Smyth et al., 1997; Schulz et al., 1998; Dekkers et al., 2000), we examined the AUC for the total waking day, D.E. Polk et al. 264 the amplitude of the morning rise, and the linear slope of the decrease over the waking day. "
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