Some people seem to wake with the lark and jump out of bed as if the world was a box of chocolates waiting to be wolfed down as breakfast. Others crawl out of bed as if they were expecting the world to end. Doctors get all technical at this point and start talking about circadian rhythms and body clocks. There’s a scientific explanation for everything if you look hard enough – without it depending on how much you had to drink the night before. Anyway, while you are young, little matters. Life goes on and you manage to get through each day until you make enough time to fit in another hour or so of sleep. But as you slowly grow older, even the larks get a little cranky in the mornings. The problem is easily explained. While you are up and moving around, all your joints are reasonably flexible. But, if you lie still for seven or eight hours, you can wake up a little stiff. This is more common among those developing rheumatism. As the cartilage degrades, friction builds up in the joints and you slow down during the day. Lying down gives the chance for the joint to swell slightly and tenderness to increase. This makes waking less of a pleasure because, as you try to get out of bed, there is more pain until you work off the stiffness.
Over the last three years, a clinical trial has been looking at different ways in which those with rheumatoid arthritis can enjoy a better quality of life. Given the additional pain on waking, this has increasingly focussed on morning stiffness. The theory being tested was that people would start each day with a more positive mood if they were less stiff. When a disease or disorder is chronic, people can easily become depressed if all they have to look forward to is loss of mobility and more pain. Treating the body and mind together can produce a better mood and improved mobility as people are more motivated to make the best of their lives within the new physical limitations.
There’s a new approach based on a well-establish drug. Prednisone has long been used to reduce inflammation in cases of arthritis. A new format has been developed to deliver a low dose, release starting about four hours after taking the tablet and the drug reaching its maximum concentration between two and three hours later. So, if you take the tablet just before going to bed, the drug begins to reduce the inflammation in your joints during the night, allowing you to wake with the maximum possible mobility. The trial tested conventional Prednisone against the low-dosage, slow-release tablets and showed a significant improvement as the timing of the treatment was matched to the sleep cycle. The most recent trial lasted for twelve months giving good quality evidence of effectiveness. The pleasing aspect of the trial was that, after the formal double-blind element, participants were allowed to continue treatment knowing which version of Prednisone they were taking. The majority opted to continue with the slow-release version.