Effects of high-dose corticosteroids on post-traumatic inflammatory mediators.

OBJECTIVE: Plasma concentrations of inflammatory mediators are substantially increased in major orthopaedic surgery. It was our hypothesis that corticosteroids would reduce the post-operative levels of inflammatory mediators in patients with ankylosing spondylitis, and we performed a single-centre randomised controlled trial. PATIENTS AND METHODS: In 20 consecutive patients, an osteotomy of the lumbar spine was done. By concealed random allocation, 10 of the patients were given 10 mg/kg of methylprednisolone pre-operatively. The control patients received the same amount of saline. Samples of arterial blood and local blood from the surgical site were sampled and analysed for inflammatory cytokines and prostaglandin E2. RESULTS: There were significant increments in systemic levels of IL-6, IL-10 and sTNF-R1. Corticosteroids significantly reduced the increases of IL-6 and significantly increased the levels of IL-10 and sTNF-R1. Locally, the expressions of TNF-alpha, IL-1beta, IL-6 and sTNF-R1 were significantly increased in both groups post-operatively. Corticosteroids significantly increased the local expressions of IL-10 and sTNF-R1. There were significantly higher local than systemic levels of inflammatory mediators except for TNF-alpha. CONCLUSION: This study shows that in traumatic injury there are generally higher local than systemic expressions of inflammatory mediators, and that the main anti-inflammatory effects of high-dose corticosteroids are suppression of systemic IL-6 and increased expressions of IL-10 and sTNF-R1, both systemically and locally.

Functional outcome after lumbar closing wedge osteotomy in ankylosing spondylitis.

This study entails a prospective evaluation of lumbar closing wedge osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Twenty patients with a median age of 52 years (range, 26-70) underwent follow-up at one year. The lumbar closing wedge osteomtomy was stabilised by metallic rods fixed by transpedicular screws. Outcome measures were quality of life (EuroQol), occiput-to-wall distance, pain, fatigue, complications, technical and radiological evaluation. The technical result was good in 16 and fair in four patients; two had neuropraxia. The deformity was reduced an average of 17 degrees (95% confidence interval 15-25 degrees) at one-year follow-up. Pain during activity, pain at night, and fatigue were significantly reduced. EuroQol improved from 0.42 to 0.69 (p = 0.002) and occiput-to-wall distance from 26 to 18 cm (p = 0.005). Functional outcome was improved after lumbar closing wedge osteotomy in ankylosing spondylitis.

Cytokine Responses to Glucocorticoids and Surgery : A Randomized Controlled Trial.

PURPOSE: This prospective randomized study was designed to evaluate the implication of high preoperative doses of glucocorticoids on the cytokine responses after surgical correction in patients with ankylosing spondylitis. PATIENTS AND METHODS: In 20 consecutive patients an extending osteotomy of the lumbar spine was done by a wedge excision. In a random manner, 10 of the patients were given 10 mg/kg of methylprednisolone ("Solum-Medrol", Pharmacia & Upjohn, Stockholm, Sweden) preoperatively. The control patients received the same amount of saline. Arterial blood was sampled before and at the end of operation and at 4 and 24 h postoperatively and analyzed for pro- and antiinflammatory cytokines. RESULTS: Surgery induced non-significant increases in TNF-α and IL-1-ß and significant increases in IL-6, IL-8, IL-10 and sTNF-R1 in both patient groups. Glucocorticoids significantly reduced increases in IL-6 and IL-8. On the other hand, increases in IL-10 and sTNF-R1 were significantly enhanced by corticoids. In both groups CRP was significantly increased at 24 h after surgery, but the increments were significantly reduced by corticoids. CONCLUSION: This study shows that surgery adds a complexity to cytokine productions in patients with ankylosing spondylitis, and that the balance of these cytokines is significantly influenced by glucocorticoids.