Early morning inflammation - explanation please?

[Broseley]

I have read on this site several times that our bodies release inflammatory substances in the early hours which is why some people take their pred at 2am. I am confused about this, as my understanding was that pred knocks out your adrenals, so they no longer produce cortisol which is the cause of the inflammation. So how do we still get inflammatory substances released? Is it caused by something else?

[PMRpro Ambassador]

Cortisol isn't the cause of the inflammation - the inflammation in PMR and GCA is predominantly due to a substance called IL-6 which is produced in the body consistently and has various roles in the body. There are dozens of such substances in the body, when the body is functioning properly they get on and do their job, in autoimmune conditions this goes awry and inflammation develops. A drug like tocilizumab/Actemra acts specifically on the production of IL-6 - pred, on the other hand, is a cover-all antiinflammatory so can be used where the mechanism isn't entirely clear.

[Broseley in reply to PMRpro]

Thank you! The three answers together make it all make sense!

[SnazzyD]

The knocking out of the adrenals is just a side-effect of the Pred, not the reason to take Pred. In fact the reason they are ‘knocked out’ is because is Pred is just an artificial form of the natural cortisol (cortisone) , so when your body is flooded with it the adrenal glands just switch off because there is so much of the artificial cortisol that they don’t need to work. This is why we hope and pray that they switch back on again when the Pred dose gets much lower.As PMRPro says the inflammation bit is separate and the Pred is there to stop it. Why can’t we just let our own cortisol do the job? It’s just not potent enough. If it was we’d be walking round with permanent moon faces, thin bones, thin skin, and all the rest of it.

[Broseley in reply to SnazzyD]

Thank you! The three answers together make it all make sense!

[DorsetLady PMRGCAuk volunteer]

My understanding, but happy to be corrected -

The primary function of cytokines is to regulate inflammation, and as such, play a vital role in regulating the immune response in health and disease. There are pro-inflammatory and anti-inflammatory cytokines.

When your immune systems is not working correctly as in PMR or other diseases then the anti-inflammatory cytokines do not work correctly and allow the pro-inflammatory ones to dominate. When this happens within the blood vessels it restricts blood and oxygen circulating around body particularly in PMR to muscles around major joints and causes pain and fatigue.

Pred is used to dampened down your overactive immune system including the cytokines, and as the normal time for them to be released in the body is around 4am if you take your medication a couple of hours before that it is in the system ready to act.

[Broseley in reply to DorsetLady]

Ah, it all makes sense now, I think! So is IL-6 a cytokine?

[DorsetLady PMRGCAuk volunteer in reply to Broseley]

Yes

[Broseley in reply to DorsetLady]

Thank you! (We need a 'Reply All' button so I can thank all three of you!)

[PMRpro Ambassador in reply to Broseley]

If you had just replied to yourself we would all have seen - at least DL and I would have, Don't know if Snazzy saves all posts she replies to. OTOH - had you replied to her, DL and I would have seen it too

[Broseley in reply to PMRpro]

OK, I replied to myself once before, as an add-on to a question, but I don't think anyone saw it.

[PMRpro Ambassador in reply to Broseley]

I'd bet DL and I did!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Yep…and if we did we would have replied.

[Broseley in reply to DorsetLady]

No replies to this one I posted below. Did you see it?

[DorsetLady PMRGCAuk volunteer in reply to Broseley]

Forum been playing up today …..feeling hot could well be connected to cytokines….not sure about the wind!

[Broseley]

Thanks, well here's an additional comment: I wake up at about 4am every morning, but it's usually my guts that are the cause. I develop bad wind (not the burping type) and my guts gurgle. I also get very hot. Is this connected with the cytokines or something else, do you think? I rarely get back to sleep before the alarm goes at 6.30.

[Ullswater]

Hi, I also would be interested in anyone's response to this, because its exactly what happens to me most nights.

[Sharitone]

I also get hot at about that time