Cytokine Responses to Glucocorticoids and Surgery : A Randomized Controlled Trial

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.

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.

Surgery induced non-significant increases in TNF-α and IL-1-β 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.

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.