A recent study shows relieving pain and getting better sleep may help lessen the severity of rheumatoid arthritis. The goal of this descriptive-correlative study was to better understand the relationship among pain, sleep, and inflammatory markers.
This information could then be used to “develop strategies to reduce inflammatory markers and prevent increased disease activity” (The American Journal of Managed Care/AJMC).
As a person with RA, you have experienced the discomfort and movement limitations from your painful and swollen joints.
Even though these struggles are a part of your auto-immune disorder, they don’t have to ruin your life. There are ways to reduce the joint inflammation which generates your pain.
Ways to reduce pain associated with RA
There are ways to reduce your RA-induced pain by avoiding certain “joint pain culprits.”
In the article “7 Joint Pain Triggers That Can Make RA Worse”, author Jennifer Warner shares tricks that can help you outsmart the disease and reduce your pain:
- Stop smoking: Smoking causes higher levels of chemical markers. These create ongoing disease activity and joint damage, even with treatment.
- Eat omega-3s: Eating 3 to 6 grams/day decreases inflammation.
- Don’t put off treatment: Catch RA early. Prompt treatment slows progression.
- Change your sedentary lifestyle habits: “Use it or lose it” applies to RA.
- Avoid high-impact exercise: It's important to build muscle strength and protect your joints, but high-impact activities like running may worsen your joint pain.
- Try to avoid stress: Stress aggravates your immune system and makes your RA worse. Seek stress-reduction techniques.
- Lose excess weight: Extra weight puts additional stress on your joints, worsening your RA.
As you know, seemingly out of the blue, your pain intensifies to the point where it’s disabling, and you may literally have trouble even getting out of bed.
Clifton O. Bingham III, MD, director of the Johns Hopkins Arthritis Center and director of research for its Division of Rheumatology spoke of a research finding: "Flares were a common part of the RA experience, even when the condition was otherwise well controlled.”
It’s suggested that “if your self-care measures, such as rest and anti-inflammatory medicines, aren’t enough, it may be time to see your Doctor. Repeated or consistent flares may indicate a need for medication adjustment or other changes in treatment to help you find relief.”
How less pain and better sleep can help
Relieving your pain may help you better control your RA, according to recent research.
In article published online October 10, 2017, Kelly Davio, author of the article, informs us the study was published in the Journal of Caring Sciences.
The study correlated the degree of RA-induced pain reported by 210 participants with known inflammatory disease markers.
To gather this information, the ‘Numeric Pain Rating Scale’ was completed by each participant.
According to Physiopedia, the test-taker chooses responses from 0 to 10, -- with higher scores representing greater pain -- to describe the degree of their pain in 11 specific areas.
Researchers then compared these individual pain scale results to each participant’s blood level of inflammatory markers used to detect RA (Lab Tests Online).
Blood markers to assess RA status
Tests routinely used to determine the inflammatory status of RA include the C-reactive protein (CRP) test and the erythrocyte sedimentation rate (ESR).
Also beneficial in assessing the inflammatory status for those with RA is the Rheumatoid Factor/RF (Mayo Clinic).
In this study, a correlation was found between pain and elevated RA markers.
The link between pain and RA markers
Research results showed those identifying RA-induced pain also had elevated RA markers.
Most of the participants (83.3%) reported moderate to severe pain, as documented on the Numeric Pain Rating Scale. Of these identified participants, 81% had positive CRP results.
For those experiencing pain, there was also a significant correlation between their pain and the marker ESR.
Conclusion: The study authors concluded that, while the potential for bias in self-reporting may be a limitation of their study, findings confirmed that pain is common among patients with RA, and has “a significant relationship with inflammatory markers.”
The research project also examined what part insufficient sleep might play in the degree of inflammation with RA.
Sleep issues and the link to RA pain markers
From the AJMC report, improving sleep can help reduce the inflammatory process central to RA as well.
They tested this previous finding with their 210 study participants, using the Sleep Disorders Questionnaire (SDQ) and the Epworth Sleepiness Scores (ESS) models to poll the study cohorts.
The SDQ has 175 questions, each with a scaling of 0-to-5, used to calculate their quality of sleep over the past month.
The Epworth Sleepiness Scores provides 8 situations for the responder to rate on a scale of 0-to-3, regarding their history of dozing off. (One example is “one hour as a passenger in a car without a break.)
Even those in the cohort group exhibiting issues common in the general population, such as sleep apnea, showed a significant relationship to the RA-markers.
“The most common self-reported sleep disorders were napping during the day (83.8%) and trouble falling asleep (73.3%).”
Conclusion: Researchers note that previous studies had already identified associations between sleep problems and increased levels of inflammatory markers.
However, this study is among the first to point to a significant relationship between inflammatory markers for both pain and sleep problems.
In the current study there was also “a significant relationship between sleep problems and inflammatory markers.”
Although the possible shortcomings of relying on self-report was again noted, “findings confirm that sleep problems are common among patients with RA, and have a significant relationship with inflammatory markers.”
The relationship between sleep and pain
From the article, How to Sleep Better with Rheumatoid Arthritis, author Mary Elizabeth Dallas informs us that “sleep difficulties can worsen the pain, fatigue, and depression often associated with RA.”
Additionally, Dennis C. Ang, MD, section chief of rheumatology and immunology and an associate professor at Wake Forest Baptist Medical Center in Winston-Salem, N.C., tells us that "Not getting quality sleep can worsen your perception of pain, so you’re less able to tolerate it."
Also, Sunita Kumar, MD, medical director of the sleep program at Loyola University Health System in Maywood, Ill., says "Chronic pain affects sleep quality and the ability to sleep well." She also notes that “poor sleep, in turn, causes more pain."
In fact, a 2010 study published in the Journal of Clinical Sleep Medicine revealed that among 162 study participants with RA, “poor sleep quality had a significant link to worse symptoms of depression, more intense pain, more fatigue, and greater functional disability.”
Sleeping tips for people living with RA
- To help establish a pattern of ‘quality sleep’, Mary Elizabeth Dallas offers these suggestions:
- Revisit pain medication dosage: You may be in need of a medication adjustment.
- Take the pressure off: To reduce pressure on painful joints, remove heavy bedding (or sleep in a bed with posts to lift covers off your body).
- Manage worries: Schedule a time during the day to journal your worries and plans to deal with them. Don’t take the worries to bed with you.
- Treat underlying health issues: Other conditions, such as sleep apnea, can interrupt healthy sleep patterns.
- Stick to a sleep schedule: It’s found we all sleep better with a dedicated go-to- bed time and a consistent time to get up.
- Get regular physical activity: Moderate exercise relieves joint pain.
- Eliminate caffeine: Caffeine is a stimulant and interferes with sleep. Caffeine is found in many beverages to include coffee, tea, and sodas. Note: even de-caffeinated drinks include some caffeine.
- Avoid naps: Sleepy? Exercise instead of napping to revitalize your system.
- Don’t drink alcohol: It prevents your brain from going into a deep, restful sleep.
- Don’t eat a large meal near bedtime: The energy-intense process of digesting food can interfere with sleep.
- Reserve your bedroom for sleep: No TV, piles of laundry to sort or even books. Dedicate your bedroom for sleep only.
- If you can’t sleep, get up after 20 minutes and go to another room and read or listen to music until you’re sleepy.
- Avoid bright lights and electronic screens before bedtime: They curtail the body’s production of melatonin, a natural sleep inducer.
It’s hoped that by applying the information in this article, you’ll be able to sleep better, reduce your RA pain, and lessen your inflammation levels.