Serum levels of hyaluronan, antigenic keratan sulfate, matrix metalloproteinase 3, and tissue inhibitor of metalloproteinases 1 change predictably in rheumatoid arthritis patients who have begun activity after a night of bed rest

Arthritis Rheum. 1999 Sep;42(9):1861-9. doi: 10.1002/1529-0131(199909)42:9<1861::AID-ANR10>3.0.CO;2-I.


Objective: To evaluate whether and how moderate physical activity following a night of rest influences serum levels of matrix metalloproteinase 3 (MMP-3), tissue inhibitor of metalloproteinases 1 (TIMP-1), antigenic keratan sulfate (Ag KS), and hyaluronan (HA) in 10 normal subjects and 38 patients with rheumatoid arthritis (RA).

Methods: Blood was obtained from 20 RA patients before they arose from a night's sleep, and again 1 and 4 hours after they had begun to perform moderate physical activity. Another 18 RA patients remained in bed and blood was sampled at the same time periods. Serum levels of MMP-3, TIMP-1, Ag KS, and HA were measured by enzyme-linked immunosorbent assay. Clinical activity was evaluated by the Lansbury index.

Results: Both in normal subjects and in RA patients who did not remain in bed throughout the period of blood sampling, levels of HA, Ag KS, and MMP-3 increased significantly during the first hour after the subjects arose: the increase in HA and Ag KS correlated with the Lansbury index in the RA group. Three hours later, levels of Ag KS had dropped to baseline values in both groups of subjects. Levels of HA remained significantly and moderately elevated in the RA group but not in the control group, while levels of MMP-3 did not drop significantly in either group. In contrast, levels of HA, Ag KS, and MMP-3 did not change significantly in RA patients who had remained in bed. Unlike the other markers, the levels of TIMP-1 remained unchanged at the different time periods in all 3 groups studied.

Conclusion: Significant changes in serum levels of some metabolic markers occur during the first hour after one arises from a night of sleep, especially in patients with RA. Measurement of the magnitude of these changes at different times in individual patients provides very different information about metabolic changes occurring in joint tissue than does measurement of the level of the markers at a single time point, as is usually currently reported.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antigens / blood
  • Arthritis, Rheumatoid / blood*
  • Bed Rest
  • Biomarkers / blood
  • Exercise / physiology
  • Female
  • Humans
  • Hyaluronic Acid / blood*
  • Keratan Sulfate / immunology*
  • Kidney Function Tests
  • Liver Function Tests
  • Male
  • Matrix Metalloproteinase 3 / blood*
  • Middle Aged
  • Time Factors
  • Tissue Inhibitor of Metalloproteinase-1 / blood*


  • Antigens
  • Biomarkers
  • Tissue Inhibitor of Metalloproteinase-1
  • Hyaluronic Acid
  • Keratan Sulfate
  • Matrix Metalloproteinase 3