That’s partly because the disease causes pain that can wake you up, says Melanie Smith, MD, PhD, rheumatologist at HSS.  And the longer you go without getting good sleep, the worse your quality of life may become, since a lack of good sleep may lead to more pain.

 “There’s a cycle people get into where they have pain, so they don’t sleep. And then they feel more pain, and they don’t sleep well,” says Dr. Smith. 

Read the full article at everydayhealth.com.

“Lack of sleep may contribute to psoriatic arthritis flares, but we need more research in this area,” said Dr. Smith, adding that the cause and effect may not be a straightforward relationship. “With sleep, maybe it’s not necessarily about being a trigger for psoriatic arthritis, but when we get less sleep, we feel more pain.”

“Another trigger can be changing or discontinuing medication,” explained Dr. Smith. That’s because a different mechanism of action might not work as well—or not work at all if you suddenly stop taking your medication. All of this can lead to worse symptoms, she said. 

Dr. Smith added that sometimes you will need to take the lead in shortening the time you are without treatment. “Sometimes it’s about making sure the doctor’s prior authorization is not running out anytime soon or if it is, letting the doctor know,” she explained. “I’m never upset about a patient advocating for themselves.”

Read the full article at healthcentral.com. 

Psoriatic arthritis (PsA) is a type of inflammatory arthritis usually linked with psoriasis. The cause of PsA isn’t yet known, but researchers believe factors such as genetics, gut biodiversity, lifestyle factors (smoking), and the environment may all play a role.

Dr. Smith explained metabolic syndrome (excess abdominal weight, high triglycerides, low HLD, elevated blood sugar and high blood pressure) and cardiovascular disease are the most common complications of PsA that she sees in her practice.

“Psoriatic arthritis is associated with metabolic syndrome and a higher risk of cardiovascular disease,” she explained. The increased risk of cardiovascular disease is due to more than untreated inflammation, Dr. Smith believes. “Something beyond inflammation is going on with psoriatic arthritis and cardiovascular health because cardiovascular issues are more associated with psoriatic arthritis than rheumatoid arthritis—another type of inflammatory arthritis,” she said.

Treating PsA does decrease the risk of cardiovascular disease, Dr. Smith explained. She said that it is also very important to stay on top of your overall health maintenance, making sure that a whole person approach to treatment is happening. “This relationship to cardiovascular disease also speaks to the importance of smoking cessation,” said Dr. Smith.

Read the full article at healthcentral.com. 

Doctors have long recommended doing some form of daily physical activity for patients with ankylosing spondylitis (AS) to reduce stiff muscles and limited mobility, and research has shown that home-based exercise programs can be beneficial. “Joints are made to move, and they are happiest when they are moving,” noted Dr. Smith. 

“With AS, the biggest progressive issue is a loss of mobility in the spine, and all the things attached to the spine,” explained Dr. Smith. Regular physical activity—including strengthening and stretching exercises that focus on good posture and a strong core—can help prevent some of the stiffness and loss of flexibility that comes with AS. “A weak core and poor posture can put added stress on the spine, which can exacerbate symptoms of AS,” she added.

In addition, exercises that strengthen the posterior chain, or back of the body, are also important, noted Sachdeva . “AS often pulls you into a forward flexed position and can make it difficult to extend your spine,” she explained. Strengthening the back of the body (including the back and glutes) can help counter this forward bend.

You don’t have to join a gym or seek out special workouts to get the benefits. A variety of exercises can easily be done at home with some basic workout tools that may help with managing AS, Sachdeva said.  

Read the full article at HealthCentral.com. 

“If you stay in any one position for too long, like being seated for several hours straight, it will cause stiffness and pain as inflammatory cells and proteins settle in the joints,” noted Dr. Smith. “This is most pronounced first thing in the morning as certain immune cells are more active at night, creating an accumulation of inflammatory cells and proteins by morning.”

Dr. Smith advised taking a two-minute movement break every 30 minutes or so when you’re seated at work or elsewhere. “Get up and stand instead of sitting, or if you can, take a short walk,” she said. “Movement increases circulation both of blood and of synovial fluid, which lubricates the joints.”

Read the full article at healthcentral.com. 

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic,  a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote. 

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.