ab22606

Effect of general anesthesia on the abnormal immune response in patients with rheumatoid arthritis

M. Tanno¹, A. Nakajima, T. Ishiwata, Z. Naito², S. Yoshino1

¹Department of Joint Disease and Rheumatism, and ²Department of Pathology, Nippon Medical School, Tokyo, Japan

ABSTRACT
Objective
To evaluate the influence of mental stress on the neuroendocrine-immune system in patients with rheumatoid arthritis (RA).

Methods
Twenty-four patients with RA and 10 patients with osteoarthritis (OA) who underwent total knee or hip arthroplasty under general anesthesia were enrolled in this study. The blood levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1Ra), tumor necrosis factor-a (TNF-a), soluble TNF receptors (TNF-Rs) and other substances related to stress were measured just before administering anesthesia on the day of the operation when the patients lay on the operating table and roughly 30 min later when the patients were under general anesthesia without mental stress. These values were compared with those at the same time on the day before the operation, which were considered as controls.

Results
In patients with RA under general anesthesia, the levels of IL-6, TNF-a, and TNF-R1 and TNF-R2 in the peripheral blood were significantly decreased compared with the levels before anesthesia (p < 0.01). Before anesthesia the levels of IL-1Ra in the peripheral blood were significantly higher, and the level of IL-1Ra was enhanced after the administration of general anesthesia, when compared with the level on the day before the operation (p < 0.01). Such changes were not apparent in patients with OA.

Conclusion
In patients with RA, excessive mental stress should be eliminated to modify the interaction between the stress-immune system and stress-endocrine system as a method to better control disease activity.

Key words
Rheumatoid arthritis, mental stress, neuro-endocrine-immune system, interleukin-1 receptor antagonist, interleukin-6.

This work was partly supported by grants from the Ministry of Education, Science, Sports and Culture and the Ministry of Health, Japan.
Please address correspondence and reprint requests to: Dr. Shinichi Yoshino, Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
E-mail: tanno@nms.ac.jp