By Flor Cianchetti
Do you think that the urge to keep your legs moving has nothing to do with your rheumatoid arthritis? Better think again. A recent review explained a possible link between these two conditions.
A constant urge to move your legs even at night, called restless legs syndrome (RLS), can disturb your sleep and affect your quality of life. Patients with rheumatoid arthritis (RA), an immune disease characterized by inflammation of the joints, are more likely to develop RLS.
Since almost everyone at some time or another may experience sleep problems, many RA patients may not give importance to their RLS symptoms, and RLS remains mostly underdiagnosed.
With the right treatment you can have both, a good night's sleep and your RA under control.
This recent review, which examined the causes of why restless legs syndrome is frequent among RA patients, was conducted by John A. Gjevre, MD, and Regina Taylor Gjevre, MD, from the Department of Medicine, University of Saskatchewan in Canada.
It is estimated that between 5 and 15 percent of the population has RLS, and women are twice as likely to have it. However, patients with RA are more likely to develop RLS than the general population, and this review reported that about 30 percent of the patients with RA have RLS.
It is important to assess RLS in patients with RA. Research has shown that poor sleep is associated with pain, mood, fatigability, stress, and disease activity in patients with rheumatologic disease.
When patients were asked whether they could distinguish between RLS and RA sensations, 91 percent of the patients were able to differentiate.
One link between RLS and RA conditions is that patients with either of these conditions usually display low levels of iron or iron stores in their blood. This review mentioned that clinical studies have shown benefit in RLS patients when they were treated with iron versus placebo (control). However, there have been no studies that have proven that specifically for RA patients who have RLS, the authors informed.
While RLS is generally considered a neurodegenerative disease, and RA a disease of the immune system, the researchers explained that there is a bidirectional communication between the brain and the immune system. The study reported that RLS has also been associated to other connective tissue disorders (Sjogren’s syndrome, scleroderma, and lupus), which are also classified as autoimmune diseases.
Furthermore, the same signaling molecules (cytokines) that are produced during inflammation by the immune system are involved in sleep physiology. Therefore there is a strong connection between the immune system and sleep, and this may explain why sleep disorders, including RLS, are common among people with RA.
Clinical trials on RA patients have reported sleep improvement when the TNF cytokines (tumor necrosis factor, a specific type of cytokine) were blocked, and when drugs (methotrexate, adalimumab, abatacept) to weaken the immune system were prescribed. This study suggested further investigations on the efficacy of blocking other types of cytokines, specifically IL-6.
The review recommended that treatment for RLS, both in RA or non-RA patients should start on normalizing the iron stores and iron levels in the blood. The second step should be the use of FDA-approved drugs that affect dopamine levels such as ropinirole, pramipexole, rotigotine, and gabapentin. However, this study advised on the proper evaluation of the risks, benefits, and dosage of drugs. The authors also discussed the potential benefits of anti-TNF therapy, since blocking TNF can alleviate pain in the joints for RA patients, and also appears to regulate sleep.
This review concludes highlighting the importance of screening rheumatic disease patients for sleep abnormalities including RLS. Presently, different treatments exist to improve RLS, and RA symptoms. RA patients should not have to suffer with additional complications caused by the lack of sleep and RLS symptoms.
This study was published on June 12 in The Journal of Autoimmune Diseases. The authors had no disclosures to make.