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Body Clock & Arthritis

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Ever wondered why symptoms of Rheumatoid Arthritis are worse in the morning, while Gout flares are more frequent in the evening and Fibromyalgia pain is intense after a sleepless night? Researchers have now identified a pattern and blamed it on disruptions in circadian rhythms – the 24-hour cycles of biologic activity that regulate sleep, immune response and many other functions.

Cortisol is the key

According to Maurizio Cutolo, MD, a professor of rheumatology at the University of Genova in Italy and a leading chrono­biology researcher, levels of cytokines, such as tumor necrosis factor (TNF) and interleukin 6 (IL-6), which play major roles in inflammatory arthritis, rise during the night. Normally, there is a corresponding midnight-to-morning rise in cortisol – a powerful anti-inflammatory produced by the adrenal glands. But people with RA don’t produce enough cortisol to suppress nighttime inflammation, leading to morning pain and stiffness.

And as cytokine production follows a 24-hour daily cycle, increasing in the evening and then falling to near zero by noon, Dr. Cutolo suggests that RA patients take modified-release corticosteroids at bedtime to help fight inflammation when it’s at its highest.

Similar disrupted circadian patterns seem to occur in gout too. A 2014 study in ‘Arthritis & Rheumatology’ found that the risk of gout flares was 2.4 times higher at night and 1.3 times higher in the early evening than during the day. Lead study author Hyon Choi, MD, director of clinical epidemiology at Massachusetts General Hospital in Boston says this may be due to a noon-to-midnight drop in cortisol levels, among other factors. If so, gout medications, like other arthritis drugs, may be more effective when taken at night.

Sleep well to fight pain

Researchers at Stanford University found that in people with fibromyalgia, insomnia and other sleep problems were interfering with normal patterns of waking and sleeping. This disruption in the circadian rhythm lead to reduced cortisol production and increased morning pain. And, they also found that treating sleep problems improved musculoskeletal pain in some, though not all fibromyalgia patients.

In fact, sleep disorders are common in almost all rheumatic diseases (including osteoarthritis, scleroderma and lupus), and there is likely to be a self-perpetuating cycle in which pain disturbs sleep, leading in turn to increased inflammation and more pain. Experts suggest that treating both sleep problems and pain may improve arthritis symptoms and even the underlying disease process.

#RheumatoidArthritis #JointPain #Osteoarthritis #Gout #Fibromyalgia #Arthritis #Lupus # scleroderma #Cortisol #musculoskeletalpain #Sleep #SleeplessNight

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This web site is run by an Arthritis Specialist based in Dubai, United Arab Emirates. On this site you will find news about the latest in arthritis, information about research results in the field, tips and information and diet and exercise, and much more.

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This web site is run by an Arthritis Specialist based in Dubai, United Arab Emirates. On this site you will find news about the latest in arthritis, information about research results in the field, tips and information and diet and exercise, and much more.

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