Findings could lead to shorter hospital stays and financial savings
The treatment of rheumatoid arthritis can be enhanced by tailoring patients’ treatment to their circadian rhythm, commonly referred to as the body clock. A team of scientists from Maynooth, Berlin, Vienna and Basel have found evidence that co-ordinating the time of treatment with the timing of disease symptoms can increase the effectiveness of such treatments, reducing joint pain and stiffness for patients.
Dr Andrew Coogan, Head of the Department of Psychology at Maynooth University, said there could be benefits for overburdened healthcare systems as well. “Given the prevalence of rheumatoid arthritis, integrating the ‘circadian concept’ into routine clinical treatment of rheumatoid arthritis could result in shorter duration of hospitalisation and a reduced financial burden on healthcare systems.”
He explains that this effect is based on a simple concept. “If pain and discomfort from rheumatoid arthritis 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, or tailoring the timing of treatments to the body clock of patients, can optimise results.”
Rheumatoid arthritis, which affects approximately 40,000 people in Ireland, is an auto-immune disease that can cause chronic inflammation of the joints and other areas of the body. There is no cure for the disease and treatment involves rest, exercise, medication and occasionally surgery.
The researchers found that the most compelling evidence for the success of chronotherapy in rheumatoid arthritis was the co-ordination of the administration of glucocorticoids (steroids) with the nocturnal rise of inflammation, which resulted in substantially reduced morning stiffness and pain compared to the same dose taken 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,” according to Dr Coogan.
Dr Coogan and his colleagues are surprised that chronotherapy isn’t higher on the agenda in terms of rheumatology theory and treatment. “Circadian rhythms of biological processes are of crucial importance for the cellular and physiological functions of the body and brain. 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 rheumatoid arthritis drug trials, but hopefully our research will have an influence on this.”
The team point out that more work in this field is required to analyse the success of chronotherapy with non-steroid drugs and to explore its impact on secondary symptoms such as sleep deprivation and depression. “Pain, depression and sleep disturbances seem to be interconnected in rheumatoid arthritis. Understanding the impact of chronotherapy on all of these areas will allow us to derive clinically relevant conclusions and improve patient care,” Dr Coogan said.
Further, chronotherapy need not be limited to the treatment of rheumatoid arthritis. “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,” explained Dr Coogan.
The study was recently published in the prestigious journal, Nature Reviews Rheumatology.