Timing of treatments key with arthritis

(30/04/2015) People with the painful condition, rheumatoid arthritis (RA), could see a major improvement in their condition if their treatments were timed in line with their body clock, Irish scientists have claimed.

According to a team from Maynooth University, they have found evidence that coordinating treatment times with the timing of disease symptoms can be beneficial.

RA is a chronic and often painful disease affecting the joints, causing them to become inflamed. Around 40,000 Irish people are affected and there is no cure.

The scientists at Maynooth, working with colleagues from Berlin, Vienna and Basel, have found that tailoring a patient’s treatment to their circadian rhythm – more commonly known as the body clock – could lead to major improvements for patients.

Tailoring the timing of treatments to the body clock of patients is known as chronotherapy.

“If pain and discomfort from RA is worse early in the morning, then using medication which is timed to address inflammation in line with the biological rhythm of the body should be a more effective solution. Chronotherapy can optimise results,” explained Dr Andrew Coogan, head of Maynooth University’s Department of Psychology.

He suggested that given the prevalence of RA, the use of chronotherapy ‘could result in shorter duration of hospitalisation and a reduced financial burden on healthcare systems’.

The scientists found that the biggest success in relation to RA was the coordination of steroids with the nocturnal (night-time) rise of inflammation. This resulted in significantly reduced morning stiffness and pain compared with the same dose of steroids being given in the morning.

“This is particularly encouraging, as night pain can lead to sleep disturbance and the psychological knock-on effects which come with that, such as depression and anxiety. Therefore chronotherapy is not only improving outcomes for a primary symptom, but may also address secondary issues.

“Patients don’t have to wake up in the middle of the night to take medication. A simple change to slow release medication taken before bedtime can prove very effective,” Dr Coogan pointed out.

He said that he is surprised that chronotherapy is not higher on the RA treatment agenda, especially given the lack of new medications to deal with this issue.

“The reality is that without a strong pipeline of new pharmaceutical solutions for many common and important conditions, we should be focusing on how to optimise the treatment options we have. It’s also surprising that chronotherapy isn’t mentioned in official guidelines for conducting RA drug trials, but hopefully our research will have an influence on this,” Dr Coogan said.

Meanwhile, the Maynooth team also highlighted that chronotherapy is not just limited to RA.

“We know that circadian rhythms may be important in many other common diseases and conditions, and the use of chronotherapy may improve outcomes in these. At Maynooth University we are especially interested in how chronotherapy may improve outcomes in psychiatric conditions, such as depression and ADHD,” Dr Coogan added.

Details of these findings are published in the journal, Nature Reviews Rheumatology.

For more information on RA, see our RA Clinic here


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