title: Air Travel, Circadian Rhythms/Hormones, and Autoimmunity.
abstract: Biological rhythms are fundamental for homeostasis and have recently been involved in the regulatory processes of various organs and systems. Circadian cycle proteins and hormones have a direct effect on the inflammatory response and have shown pro- or anti-inflammatory effects in animal models of autoimmune diseases. The cells of the immune system have their own circadian rhythm, and the light-dark cycle directly influences the inflammatory response. On the other hand, patients with autoimmune diseases characteristically have sleep disorders and fatigue, and in certain disease, such as rheumatoid arthritis (RA), a frank periodicity in the signs and symptoms is recognized. The joint symptoms predominate in the morning, and apparently, subjects with RA have relative adrenal insufficiency, with a cortisol peak unable to control the late night load of pro-inflammatory cytokines. Transatlantic flights represent a challenge in the adjustment of biological rhythms, since they imply sleep deprivation, time zone changes, and potential difficulties for drug administration. In patients with autoimmune diseases, the use of DMARDs and prednisone at night is probably best suited to lessen morning symptoms. It is also essential to sleep during the trip to improve adaptation to the new time zone and to avoid, as far as possible, works involving flexible or nocturnal shifts. The study of proteins and hormones related to biological rhythms will demonstrate new pathophysiological pathways of autoimmune diseases, which will emphasize the use of general measures for sleep respect and methods for drug administration at key daily times to optimize their anti-inflammatory and immune modulatory effects.
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico.
authors.forename: J
authors.initials: J
authors.lastname: Torres-Ruiz
authors.affiliation: Research Laboratories and Academic Division of Clinical Rheumatology, Director Postgraduate School on Rheumatology-Department of Internal Medicine, University of Genoa, Genoa, Italy.|IRCCS San Martino AOU, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sulli
authors.affiliation: Research Laboratories and Academic Division of Clinical Rheumatology, Director Postgraduate School on Rheumatology-Department of Internal Medicine, University of Genoa, Genoa, Italy.|IRCCS San Martino AOU, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cutolo
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5265601, Tel-Hashomer, Israel. Shoenfel@post.tau.ac.il.
authors.forename: Y
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D064870:Air Travel; D000818:Animals; D001327:Autoimmune Diseases / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D015551:Autoimmunity; D057906:Circadian Clocks; D002940:Circadian Rhythm / Q000276:immunology; D006728:Hormones; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D012892:Sleep Deprivation
chemical_list: D006728:Hormones
keywords: Autoimmunity; Biological rhythms; Circadian; Flights