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.

RCT Entities:   Population Interventions Outcomes