R: The timing of glucocorticoid administration in rheumatoid arthritis. Ann Rheum Dis

Objective—To test the hypothesis that the timing of prednisolone administration might be critical in determining its eVect on the diurnal rheumatoid inflammatory process. Methods—26 patients with rheumatoid arthritis were randomly divided into two equal groups and allocated to low doses of prednisolone at either 2.00 am or 7.30 am. Because of the diurnal variation in disease activity in rheumatoid arthritis, assess-ments of the two study groups were performed at 7.30 am both at the start of the study (day 1) and after four doses of prednisolone (day 5). The study protocol diVerences in the time period from the last dose of prednisolone to assessment were 5.5 hours in the 2.00 am group and 24 hours in the 7.30 am group. Results—Administration of low doses of prednisolone (5 or 7.5 mg daily) at 2.00 am had favourable eVects on the duration of morning stiVness (P << 0.001), joint pai