Can anti-inflammatories improve the morning stiffness of rheumatoid arthritis? – Medical Information Bulletin

Morning stiffness is a common problem among people with rheumatoid arthritis. Drugs & Aging examined evidence that anti-inflammatory drugs can help reduce stiffness morning.

We rely on our immune system to defend ourselves against bacteria and viruses.In the case of rheumatoid arthritis, the immune system targets the joints, which, over time, can cause joint damage, resulting in severe pain, reduced mobility and decreased quality of life

Joint pain and stiffness experienced by people with rheumatoid arthritis tend to worsen in the morning, and morning stiffness can be severe and debilitating A rheumatologist from Hong Kong wrote a review article that summarizes research on morning stiffness, and whether or not not the most recently developed anti-inflammatory drugs can reduce its severity. The journal was published in the scientific journal Drugs & Aging

What is the severity of morning stiffness?

In a clinical study, more than two-thirds of patients with rheumatoid arthritis experienced morning stiffness. One-quarter of patients experienced morning stiffness for at least one hour. Another study found that half of the patients had a stiffness that lasted more than one hour. Interestingly, another study found that the duration of morning stiffness decreased in patients who had had rheumatoid arthritis longer. The review also noted that morning stiffness studies usually measure only the duration of stiffness rather than the severity of the pain or the degree of disability.

Morning stiffness can significantly affect morning, social and social functions. life. People with severe morning stiffness were more likely to take early retirement and patients with more severe morning stiffness were more likely to be unable to work at all.

In another study, retirees with rheumatoid arthritis stop working before the normal retirement age. The majority of these retirees said that morning stiffness was the main reason for their retirement. Nearly half of workers with rheumatoid arthritis reported that morning stiffness had a negative impact on work performance. Almost one-third said that morning stiffness sometimes led them to be late for work.

Do new anti-inflammatory medications relieve morning stiffness?

Over-the-counter anti-inflammatory medications such as aspirin or ibuprofen can temporarily relieve pain. or stiffness, but they have no effect on the long-term prognosis of the underlying disease. Other drugs, such as methotrexate, have typically been used to treat rheumatoid arthritis. These work through a variety of biological mechanisms.

In recent decades, researchers have developed novel anti-inflammatory drugs designed to specifically target and inhibit the proteins involved in inflammation and immune response. The targeted nature of these drugs is to make them safer and more effective than previous treatments. These medications include adalimumab (Humira), baricitinib, etanercept (Enbrel), infliximab (Remicade), rituximab (MabThera or Rituxan), sarilumab (Kevzara) and tocilizumab ( Actemra).

Clinical trials have confirmed the effectiveness of these drugs to treat rheumatoid arthritis and morning stiffness. All medications were found to decrease the average duration or severity of stiffness in the morning. Some of these trials also compared the effectiveness of the drug to a placebo or conventional treatment for rheumatoid arthritis. Sarilumab and baricitinib were both more effective than placebo in reducing the duration or severity of morning stiffness. Both infliximab and etanercept were more effective in reducing the duration of morning stiffness compared to older medications.

The studies were all different in conception and presented stiffnesses in different ways. It was therefore not possible to directly compare the results of each study with each other. For example, in a tocilizumab study, the mean duration of morning stiffness was reduced by 50% (2.4 to 1.2 hours) after four weeks of treatment. Another tocilizumab study found that half of the patients treated had a shorter duration of morning stiffness, but only 19% of patients experienced a reduction greater than 1 hour. Other studies have reported even more impressive effects: for example, patients taking infliximab had an average duration of morning stiffness reduced by 70%

Are anti-inflammatory glucocorticoids useful for treating Morning stiffness?

Glucocorticoids as prednisone a type of steroid hormone that suppresses the immune system and decreases inflammatory activity. They are very effective in reducing the severity of rheumatoid arthritis, but long-term use can lead to serious side effects, including an increased risk of death. This risk requires careful monitoring and special attention to dosage, but the rapid effect of glucocorticoids means that they can be particularly effective when the drug's administration coincides with morning stiffness. For example, recent studies have shown that taking prednisone early in the morning, or delayed-release prednisone at bedtime, effectively decreases stiffness in the morning.

There are effective treatments for morning stiffness in rheumatoid arthritis

being attentive to morning stiffness in their patients, preferring to rely on other measures of the severity of the disease. However, morning stiffness largely contributes to the negative effects of rheumatoid arthritis on quality of life. For this reason, morning stiffness should be evaluated regularly in the clinic. This is especially true since medications can partially relieve morning stiffness in many patients. However, there is no standard practice for assessing the severity of morning stiffness, as most clinical studies rely solely on duration, rather than quantifying the severity of pain. Researchers and physicians need to develop a standardized method for measuring morning stiffness to better facilitate the treatment of this important consequence of rheumatoid arthritis.

Written by Bryan Hughes, PhD

Reference: Mok, CC Morning stiffness in elderly patients with rheumatoid arthritis: what is known of the effect biological and targeted agents? Drug and Aging (2018).