Waking Up To The Morning Symptoms Of Rheumatoid Arthritis (RA)

European-wide research published today in the Annals of the Rheumatic Diseases1,2,3 reveals the real impact of the morning symptoms of rheumatoid arthritis (RA) on a patient's working ability and quality of life, with 83% of those with severe morning stiffness (n=170), agreeing that the difficulties caused by morning stiffness and pain control their lives.1

The survey of 750 RA patients and 518 rheumatologists across 11 countries carried out by Ipsos MORI and commissioned by Mundipharma International Limited, reveals the effect of stiffness and pain in the morning on working ability: 73% of those patients in paid employment (n=274) report that these symptoms have a significant impact on their jobs, with 96% of patients in Poland (n=50) and 90% of those in Italy (n=100) being most affected.3,2 Among working patients (n=274), almost half (47%) are sometimes unable to work and 45% of those losing time from work in the last 6 months (n=110) have taken more than 10 days off due to these symptoms.2

Although the majority of patients (82%) and over 87% of rheumatologists agree that morning stiffness and pain have an impact on patients' quality of life, almost two-thirds of rheumatologists (61%) say that they do not specifically treat these symptoms.3

Douglas J. Veale, Professor of Medicine and Consultant Rheumatologist at St Vincent's University Hospital and a Principal Investigator at The Conway Institute for Biomedical and Biomolecular Research, University College Dublin says: "It is clear from this research that morning stiffness and pain associated with RA have both an emotional and economic impact on patients' lives, often affecting their ability to work. We need to ensure these symptoms are discussed with patients so that any negative impact on their lives is addressed and minimised."

A complexity of RA symptoms including physical dysfunction, stiffness and pain in joints (particularly affecting the hands) can lead to difficulty in carrying out tasks in the morning. Lodotra® (modified-release prednisone) is a treatment for moderate to severe RA, in particular for those who suffer from morning stiffness. In RA increased serum pro-inflammatory cytokine levels during the night are associated with joint stiffness in the morning.4,5 Deregulation of the inflammatory process and production of pro-inflammatory cytokines such as IL-6 have been found to contribute to inflammation of the synovial membrane (the inner membrane of tissue that lines a joint), while the rise of IL-6 levels, specifically in the early morning, has been associated with morning stiffness of the joints.4,5,6

Taken at bedtime (about 10.00pm), Lodotra utilises a modified-release mechanism to release low-dose prednisone four to six hours after intake, at a time in the early morning when inflammatory mediators build up.6 Maximum levels of prednisone in the blood are reached around six-nine hours after ingestion, to coincide with the time when concentrations of pro-inflammatory cytokines such as IL-6 are at their natural peak in RA. 4,5,7 This night time release of prednisone results in a marked suppression of nocturnal IL-6 levels and a significant reduction in the relative duration of joint stiffness on waking compared to conventional prednisone taken in the morning