Domiciliary self-measurement in the rheumatoid arthritis and the demonstration of circadian rhythmicity.

Abstract

SUMMARY Symptoms and signs of rheumatoid arthritis vary within the day and from day to day. Interesting and possibly important observations can be missed when evaluations are based only on outpatient measurements, which are likely to be made at only one time and at infrequent intervals. We have found that patients can measure their own grip strength and finger joint sizes at home, and simultaneously assess overall pain and stiffness on numerical scales. Measurements made by patients were reproducible when made at the same time of day if on the same treatment. The patient's subjective assessment of pain and stiffness is a useful measure of the severity of rheumatoid arthritis. These pain and stiffness ratings were found to be well correlated with the patient's objective measurements of finger joint size and grip strength. Information not otherwise available can be collected by studying patients at home with these self-measurement techniques. These have allowed the demonstration of circadian variations in the signs and symptoms of rheumatoid arthritis and improved the evaluation of drugs studied in clinical trials.

Aspects of Human Chronopathology

“…The symptoms and signs of rheumatoid arthritis vary within and between days (Scott 1960;Delbarre 1979;Kowanko et al 1981Kowanko et al , 1982aHarkness et al 1981Harkness et al , 1982. Although the major symptoms of this common disease are pain, stiffness, and inflammation, systematic investigation of the temporal variation in these have been carried out only on a few occasions (Delbarre 1979;Kowanko et al 1981Kowanko et al , 1982bHarkness et al 1981Harkness et al , 1982.…”

Chronobiological characteristics of painful diabetic neuropathy and postherpetic neuralgia: Diurnal pain variation and effects of analgesic therapy

“…For example, pain in rheumatoid arthritis occurs mostly at the beginning of the day (Kowanko et al, 1982) whereas pain due to osteoarthritis occurs mostly at the end of the day (Bellamy et al, 1990). Rigas et al (1990) studied the circadian rhythm of biliary colic in patients undergoing cholecystectomy for symptomatic biliary tract stones.…”

Chronopharmacology of Mizoribine in Collagen-Induced Arthritis Rats

“…Pain, functional disability, and stiffness show 24-h rhythms, with a peak in the early morning in many RA patients (31,32), and the rhythms of pain and stiffness may play a role in local and systemic inflammatory responses. Herold and Günther reported that plasma CRP levels, an indicator of inflammatory responses, showed a 24-h rhythm with a peak in the early morning in RA patients, which matched the rhythms of pain and stiffness (33).…”