Managing Insomnia Could Help Prevent Rheumatoid Arthritis

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Insomnia may significantly increase the risk of developing rheumatoid arthritis (RA), although managing it could lower this risk.

No genetic link was found between insomnia and other rheumatic conditions, including ankylosing spondylitis (AS), osteoporosis or gout.

“Insomnia is closely tied to inflammation, with numerous studies showing that sleep disorders correlate with elevated systemic inflammation,” wrote a team of investigators from the Department of Joint Surgery at HongHui Hospital, Xi'an Jiaotong University, China. “Insomnia significantly alters inflammatory mediators, such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), with increased IL-1β and reduced TNF-α levels indicating a dysregulated immune response to sleep deprivation.”

Previous research has reported that people suffering from insomnia — one of the most common complaints among patients with autoimmune conditions — may be at a significantly increased risk of developing a rheumatic disease.

RA is a chronic autoimmune disease caused by a combination of factors, including inflammation, genetic predisposition and immune system dysfunction. Data show that sleep problems and immune dysfunction are closely linked, forming a vicious cycle: Poor sleep worsens immune function, while inflammation from RA disrupts sleep.

Poor-quality or insufficient sleep reduces the activity of regulatory T cells (Tregs), which help control the immune response. This dysfunction can lead to autoimmune diseases such as RA. Additionally, sleep disturbances increase inflammatory proteins, which are heavily involved in the progression of the disease.

Investigators evaluated the genetic connection between insomnia and rheumatic diseases using genome-wide association study (GWAS) summary data from a large sample of people of European descent collected from the UK Biobank, 23andMe and the FinnGen consortium website.

The analysis found a genetic link between insomnia and an increased risk of RA, with insomnia raising the odds of RA by about 11%. This aligns with other studies that have shown a significant link between the two conditions, including one that reported up to 70% of people with insomnia have concomitant RA. These results suggest a greater biological connection between RA ad insomnia, with more than stress and inflammation as the driving causes.

Although no genetic connection was found between insomnia and the other rheumatic conditions, other factors — such as lifestyle, environmental and psychosocial — may influence this relationship. Sleep hygiene, exercise, diet and medication may all contribute to the development or the amplification of the underlying conditions as well as sleep issues.

Investigators noted these results highlight the need to consider nongenetic mechanisms, such as stress, inflammation and external exposures when understanding how AS, gout and osteoporosis develop in patients with concomitant insomnia. The absence of a genetic component suggests that the reasons underlying the comorbidity are more complex and multifactorial than previously thought. Findings provide an opportunity to inform more effective prevention and management approaches.

Results were consistent and reliable, as there were no irregularities in the genetic data or unexpected effects influencing the outcome.

Investigators mentioned restricting the sample to individuals of European descent may have limited the generalizability of the results, as genetic and environmental factors may vary across populations. They suggest that future research include a more diverse sample population. However, the findings provide valuable information on the significant genetic links between RA and insomnia.

“Clinicians should be vigilant in monitoring insomnia patients for early RA signs, given the genetic overlap between the two conditions,” investigators advised.