According to researchers at Semmelweis University, not only inflammation, but also sleep disorders, depression, obesity, and smoking may sustain persistent rheumatic symptoms. In their publications in the journals Nature Reviews Rheumatology and The Lancet Rheumatology, they also proposed a model that can help identify and treat the true causes of symptoms in time.
Researchers at Semmelweis University analyzed how depression, smoking, obesity, sleep disorders, and other health problems are linked to difficult-to-treat rheumatoid arthritis.
Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the joints, causing pain, swelling, and stiffness. It affects tens of thousands of people in Hungary only. Most patients respond well to treatment, but 6–28 percent belong to the so-called “difficult-to-treat” group because they do not achieve lasting remission despite therapy.
According to the publications in Nature Reviews Rheumatology and The Lancet Rheumatology, these factors may not only coexist with the disease but may also help maintain it.
For example, pain and depression may reduce physical activity, increase body weight, worsen sleep and mood – all of which can feed back into pain and everyday functioning, creating a difficult-to-break “vicious cycle.”
The researchers not only identified these patterns but also developed a new model that could improve the treatment of such difficult-to-treat patients. Under the currently used “treat-to-target” therapeutic approach, patients’ conditions are regularly monitored using measurable indicators, and if treatment does not sufficiently reduce inflammation, therapy is adjusted – for example by increasing the medication dose or switching to another drug. However, according to the researchers, this approach can function not only as a therapy but also as a kind of “early warning system”: it can quickly indicate when symptoms may not be caused solely – or at all – by inflammation.
“When target values improve but the patient still suffers from pain and fatigue, it is worth taking a step back. In such cases, instead of automatically prescribing more medication, doctors should look for what is maintaining the symptoms – whether it is chronic pain syndrome, depression, sleep disorders, or obesity,” said Dr. György Nagy, head of the Department of Rheumatology and Immunology at Semmelweis University. The researchers themselves have observed that this approach can improve outcomes for difficult-to-treat patients, and in many cases it can also positively affect the doctor–patient relationship.
The researchers’ model has achieved major international recognition: the publications introducing the concept of “difficult-to-treat” disease and the related treatment strategy have already been cited more than a thousand times by other researchers. Moreover, the definition is now used worldwide not only in the context of rheumatoid arthritis but also in connection with other diseases.
Meanwhile, the team is already working on the next steps: alongside their own research, they are planning to join projects that would use artificial intelligence to develop even more effective therapies for people with rheumatoid arthritis.
“With AI-based pattern recognition, we could identify subgroups among patients, and with the help of these data we could create more effective, almost personalized treatment strategies for them,” explained Dr. Lilla Gunkl-Tóth, PhD student at Semmelweis University and first author of the publications.
Photo: Boglárka Zellei – Semmelweis University
Cover: elements.envato.com/voronaman111
