Poor sleep also limits patients' ability to cope with their disease. This can be a vicious cycle in people with Rheumatoid Arthritis. Arthritis-related inflammation causes pain and stiffness, which interferes with sleep, which further aggravates inflammation.

Many factors affect sleep quality in people with Rheumatoid Arthritis, including how long a patient has had arthritis, disease activity, pain level, depression symptoms and adherence to medication. Arthritis interferes with our circadian rhythms, or our internal 24-hour clock, affecting how much sleep we get and the quality of our sleep. The genes that control this body clock can activate a protein called TNF-alpha (tumor necrosis factor), which increases inflammation and causes Rheumatoid Arthritis patients to experience more pain and stiffness in the morning.

The number of hours of reported sleep the previous night is a highly significant predictor of the current day's pain frequency. Less than six, or more than nine, hours of sleep are associated with greater next-day pain. Some pain medications are also associated with increased sleep disturbance.

Clearly, consistently getting a good night's sleep should be an integral part of every patient's overall arthritis treatment. Pain-related sleep disturbances can also be a good barometer as to how a patient is responding to treatments for chronic pain.

Physicians have several treatment options that may help patients with arthritis sleep better at night...

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