No abstract

This study showed a causal relationship between psychosocial stressors and urine neopterin concentrations that may be related to SLE disease activity. Furthermore, the workability of an integrative approach using single-case design and time-series analysis in psychoneuroimmunology was demonstrated for the first time.

This study on a patient with systemic lupus erythematosus (SLE) investigated the impact of positive emotionally pleasing incidents on hypothalamus‐pituitary‐adrenal (HPA) axis and cellular immune system activity under complex everyday conditions. A 52 year‐old woman collected her entire urine for 56 days in 12‐h intervals for the determination of cortisol and neopterin, a cellular immune parameter. Psychological variables were based on daily questionnaires and weekly interviews. Time series analysis consisted of ARIMA modeling and cross‐correlational analysis. Positive everyday incidents were associated with three distinct emotional reactions: short‐term positive reactions, anticipatory negative reactions, and long‐term negative reactions. Short‐term positive reactions were associated with a decrease in urine cortisol after 36 h and an increase after a total of 48 h, while urine neopterin increased 24 h after the incidents and decreased after a total of 84 h. Anticipatory negative reactions were associated with an initial increase in urine cortisol 24 h before the incident occurred and with a subsequent decrease a total of 12 h following the incident. Long‐term negative reactions were associated with an ultimate increase in urine neopterin 144 h after the incidents. These findings empirically demonstrate that one specific category of positive everyday incidents can be associated with multiple emotional reactions that differ in valence (positive/negative) and duration (short‐term/long‐term), and also depend on whether an incident was expected (anticipated/not anticipated). This calls for a careful categorization of positive incidents when testing stress system functioning under complex everyday life conditions. Copyright © 2006 John Wiley & Sons, Ltd.

Background: This study on a breast cancer survivor investigated how episodic practice of various complementary and alternative medicine (CAM) techniques affected the dynamics of emotional states and urinary neopterin—an inflammation marker. Methods: The 49-year-old female patient (diagnosis: ductal breast carcinoma 5 years before study start, suffering from chronic fatigue and depression) collected her entire urine in 12-hour intervals (from about 8 a.m. to 8 p.m. and from about 8 p.m. to 8 a.m.) for 28 days. The resulting 55 consecutive urine samples were analyzed for neopterin and creatinine levels using HPLC. Also in 12-hour intervals, the patient filled out questionnaires on emotional states and everyday routine, including CAM practice. Weekly, she was interviewed to identify emotionally meaningful everyday incidents, including use of CAM techniques. Time series analysis consisted of ARIMA modeling and cross-correlational analyses. Results: Qualitative evaluation revealed that, with the exception of Tai Chi, all CAM techniques, that is, Jin Shin Jyutsu, music, physiotherapy and energy healing, were experienced as positive. Cross-correlational analyses showed that practice of such CAM techniques was followed first by significant ( P < .05) increases in positive mood and mental activity on the same day (lag 0) and then by decreases in positive mood after a total of 72 to 84 hours (+lag 6) and in mental activity after a total of 84 to 96 hours (+lag 7). Negative mood, by contrast, first decreased on the day of CAM practice (lag 0) and then increased after a total of 84 to 96 hours (+lag 7) following CAM. Moreover, urinary neopterin levels first increased on the day of CAM practice (lag 0) and then decreased after a total of 36 to 48 hours (+lag 3). Similar biphasic effects were also detected for irritation in response to CAM, although only partly significant. Conclusion: Cyclic psychophysiological response patterns following CAM practice were attributable to biopsychosocial feedback mechanisms involving personally meaningful experiences. As lower neopterin levels following CAM point to a health-promoting effect, the patient of this study may have actively contributed to her healing process through episodic CAM practice.

BackgroundLittle is known about the real-time cause-effect relations between IL-6 concentrations and SLE symptoms.MethodsA 52-year-old woman with mild SLE activity collected her entire urine for the determination of IL-6/creatinine and protein/creatinine levels (ELISA, HPLC) for a period of 56 days in 12 h intervals (total: 112 measurements). Additionally, she answered questionnaires (VAS) on oral ulceration, facial rash, joint pain, fatigue and tiredness and measured her temperature orally twice a day. Time-series analyses consisted of ARIMA modeling and cross-correlational analyses (one lag = 12 h, significance level = p &lt; 0.05).ResultsStatistical analyses showed that increased urinary IL-6 concentrations preceded increased urinary protein levels by 36–48 h (lag3: r=+.225; p=.017) and that, in the opposite direction of effect, increased urinary protein preceded urinary IL-6 decreases by 12–24 h (lag1: r=–.322; p&lt;.001). Moreover, urinary IL-6 increases co-occurred with increased oral ulceration (lag0: r=+.186; p=.049); after 48–60 h, however, IL-6 increases showed a strong tendency to precede oral ulceration decreases (lag4: r=–.170; p=.072). Increases in facial rash preceded decreases in urinary IL-6 after 84–96 h (lag7: r=–.215; p=.023). As to fatigue, increases in urinary IL-6 co-occurred with decreased fatigue (lag0: r=–.193; p=.042); after 84–96 h, however, IL-6 increases preceded fatigue increases (+lag7: r=+.189; p=.046). Finally, joint pain, tiredness and body temperature did not significantly correlate with urinary IL-6 concentrations in either direction of effect.ConclusionsThe results of this evaluation point to real-life feedback mechanisms between immune activity and SLE symptoms. Comparison with a previous evaluation of this patient suggests a counterregulatory mechanism between Th1 activity and IL-6. These findings are preliminary and require replication to draw firm conclusions about the real-time relation between IL-6 and SLE disease activity.