An interesting article about arthritis focused on the chronobiology of the disease. The article is entitled “Chronobiology and the Treatment of Rheumatoid Arthritis.” The author is Maurizio Cutolo. It was published in Current Opinion in Rheumatology in 2012. This paper will examine and analyze this article. This includes the generalizability of the work, its outcomes and a brief summary of the article. Furthermore, it will discuss how this applies to clinical practice.
The article examined how the neuroendocrine immune system impacts the body. In particular, the circadian rhythms have significant effects on the body’s response. The body releases many of the hormones responsible for this during the nighttime period of the day. This article focuses on how the regulation of these hormones impact individuals with rheumatoid arthritis (RA). According to the author, “the stiffness and functional disability characterizing the early morning hours is consistent with the reduced night adrenal cortisol production, which under the chronic stress of the disease becomes insufficient to inhibit the ongoing immune/inflammatory reaction” (Cutolo, 2012, p. 13). Understanding how the hormones impact a disease, and particularly how daily fluctuations in the body impact the disease is an important way to learn how to control the disease’s signs and symptoms. The author recommends adjusting the dosing of medications based upon the circadian rhythms.
This article offers a significant input into other diseases, hence it is generalizable. Many diseases are auto-immune in nature and therefore this information can be applied to them as well. Since the author focuses on how glucocorticoids are impacted by the daily changes in hormones related to the circadian rhythm, this information may be used in other diseases, such as polymyositis, multiple sclerosis, and even acute arthritis flare-ups, per the author. It is important for science and medicine to recognize that the human body does have a natural rhythm to it. While science and medicine does have a significant amount of information with regards to the circadian rhythm, it has not been applied to the treatment of many diseases. Furthermore, it has not been applied to any significant disease with the adjustment of medication doses.
It is likely that this information will have a significant impact on my practice. This article provided useful information as to how the circadian rhythm and the neuroendocrine hormones and immune system can help to regulate the use of many medications in the body. Unfortunately, modern medicine does not adjust the level of medications based upon the time it is administered to the patient. This apparently may be a mistake for the body. The human body is not meant to have a standard level of medications administered throughout the 24 hour cycle. Many of the medications impact the hormones in the body. The xenobiotic chemicals that are placed into the body should also be adjusted. This is termed chronotherapy. Obviously, chronotherapy is an alternative way to treat patients; it is not the standard medical or nursing method. However, as an alternative treatment, chronotherapy does appear to offer benefits for the patient. This also suggests that other alternative and complementary treatments may offer similar benefits for individuals.
As a practitioner, it is important to recognize that many other types of treatment exist. These alternative and complementary treatments can be used in conjunction with standard protocols or as an entirely different form of treatment for the patient. Chronotherapy is being used successfully for the treatment of rheumatoid arthritis. This alternative treatment recognizes the importance of the circadian rhythm in determining the treatment modalities of the patient. This knowledge will greatly impact how I treat patients in the future. Because of this article, I have become aware of the idea of chronotherapy and will likely use this as a method of patient care at some point.