Search Results (284)

Background: Cannabidiol (CBD), the major non-psychotropic cannabinoid derived from Cannabis sativa L., has demonstrated broad anticancer activity across multiple tumor types; however, its effects in renal cell carcinoma (RCC) remain largely undefined. Given the ongoing need for novel therapeutic strategies in RCC, this study provides preliminary mechanistic insights into the cytotoxic, antiproliferative, and redox-modulating properties of CBD in RCC cells and evaluates the influence of serum conditions on its activity. Methods: Human RCC cell lines (Caki-1 and 769-P) and non-tumoral proximal tubular epithelial cells (HK-2) were treated with CBD (1–100 µM) for up to 48 h under serum-free and serum-supplemented (5%) conditions. Cytotoxic and antiproliferative effects were assessed using the MTT assay, and intracellular reactive oxygen/nitrogen species (ROS/RNS) levels were quantified using the H₂DCFDA fluorescence assay. Results: CBD significantly decreased RCC cell viability and proliferation in a concentration-dependent manner and induced time-dependent ROS/RNS accumulation. Comparable sensitivity was observed in non-tumoral HK-2 renal epithelial cells, indicating limited tumor selectivity under the tested in vitro conditions. Notably, these effects were markedly attenuated in the presence of serum, consistent with CBD’s high serum–protein binding and reduced free bioavailability. Conclusions: CBD induces cytotoxic, antiproliferative, and redox-modulating effects in RCC cells in vitro; however, these responses are strongly attenuated by serum, lack tumor selectivity, and require concentrations exceeding clinically achievable plasma levels. Together, these findings delineate major translational limitations for the therapeutic use of CBD in RCC. Full article

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article

People with intellectual disabilities frequently use psychotropic and other medications, sometimes inappropriately. To promote shared decision-making, they require accessible information about their medication. This study combined data from two similar intervention studies, conducted in two different settings, to assess the appropriateness of medication use and the shared decision-making process among adults with mild intellectual disabilities who used psychotropic medication. The intervention consisted of a structured, multidisciplinary medication review, including the provision of accessible psychotropic medication leaflets, and a discussion of the pharmacotherapeutic treatment plan with the patient by either a pharmacist or physician, depending on the setting. Outcomes included medication use, pharmacotherapeutic problems, implementation of recommendations, and perceived shared decision-making, measured with the Shared Decision-Making Questionnaire Q9. The 15 included participants used an average of nearly seven medications, which were mainly neurotropic, gastrointestinal, cardiovascular, and respiratory agents. On average, two pharmacotherapeutic problems were identified; the most common were overtreatment, side effects, and administration difficulties. Recommendations often involved dose reduction or tapering, and about 75% were fully or partially implemented. Both participants and clinicians reported high satisfaction with shared decision-making. Multidisciplinary, structured medication reviews, incorporating accessible medication leaflets, may enhance appropriate medication use and shared decision-making, but more research is needed. Full article

Cathinone and its synthetic derivatives are among the most popular classes of narcotics worldwide. Experimental studies have demonstrated variable cytotoxic activity among these substances. Until now, the research on cathinones has been limited to their psychotropic activity. Therefore, the structure–activity correlation in this group remains poorly understood. The current study aimed to expand the understanding of the influence of cathinone structural modifications on cytotoxic activity. A group of cathinones whose cytotoxic activity has been experimentally analyzed by a single research group was studied in silico using density functional theory (DFT). A systematic characterization of the substituent effect and the aromaticity changes depending on the polarity of the medium is presented in this paper. A correlation between growing electron-withdrawing properties of the N-end and its carbonyl fragment as well as aromaticity decrease with growing cytotoxic activity were observed. Full article

Background: Sexualized substance use (SSU) describes the use of psychotropic substances in the context of sexual activity. Less is known about the role of sexualized substance use among individuals with substance use disorders (SUD) and its effect on the course of the disorder, e.g., regarding relapses after abstinence. Methods: A convenience sample of individuals undergoing SUD rehabilitation in Germany was surveyed. A questionnaire asked about SSU, sex as a risk factor for relapse, and the importance of sexuality in treatment. Results: N = 490 (30.1% female) participated; 55% of men and 63% of women reported SSU, and 56.5% of heterosexual and 82.9% of homosexual men reported SSU (p < 0.017; r = 0.20). Stimulant users are more likely to report SSU than alcohol (p < 0.001) and sedative users (p < 0.001; r = 0.296 and r = 0.261). Furthermore, 15% of women and 18% of men consider sexual activity a risk factor for relapse; homosexual men (65%) consider it significantly more often than heterosexual men (14%), while 41.2% of heterosexual women and 55% of homosexual women consider it a factor. Additionally, 27.4% of heterosexual and 69.4% identified sexuality as an important topic for therapy, while 19.8% of heterosexual women, 30% of homosexual women, 13.5% of heterosexual men, and 47.2% of homosexual men reported that sexuality had been addressed in their therapy. Conclusions: SSU was reported by individuals with a SUD who were undergoing rehabilitation treatment. Furthermore, patients consider sexual activity as a potential risk factor for relapse, with this being particularly the case for stimulant users. The topic of sexuality is highly important for patients and should, therefore, be given greater consideration in therapy in the future. Full article

Over the past decade, significant progress has been made in the treatment of chronic hepatitis C virus (HCV) infection. The introduction of direct-acting antivirals (DAAs) has revolutionized the treatment of HCV infection, offering nearly 100% efficacy. Furthermore, additional therapeutic regimens with pangenotypic efficacy have been registered. These drugs are also characterized by a few adverse events and good treatment tolerance. As DAA therapy is now accessible to virtually all patients, including those with multimorbidity who often take multiple medications, drug interactions (DDIs) have become a significant clinical challenge. One of the groups of patients who are frequently infected with HCV is those with mental disorders. Due to frequently overlapping metabolic pathways, DDIs can occur, affecting the effectiveness of both psychiatric and antiviral therapy. Knowledge of these interactions is crucial in these cases and influences patient management. This paper discusses the most significant interactions between pangenotypic DAA regimens and psychotropic medications. Full article

Ground meat is highly perishable and has a short shelf life due to microbial contamination with food spoilage bacteria along with foodborne pathogens, which increases the risk of food poisoning. Controlling microbial growth by using chemical or synthetic food additives or preservatives is of great health concern. Natural, plant-derived antimicrobial food additives are safer alternatives. Therefore, the main objective of this study was to evaluate the antimicrobial efficacy of different forms and concentrations of clove against food spoilage and foodborne pathogens and to determine their ability to enhance sensory quality and extend the shelf life of buffalo meatballs during refrigerated storage. Clove oil (0.25, 0.50, and 1.0 g/kg), clove extract (0.5, 1.0, and 1.5 g/kg), and clove powder (2.5, 5.0, and 7.5 g/kg) were assessed against aerobic plate counts (APCs), psychotropic counts (PCs), and foodborne pathogens such as Staphylococcus aureus, Salmonella enterica serovar Typhimurium, and Escherichia coli O157:H7, artificially inoculated in buffalo meatballs. Clove oil, clove extract, and clove powder treatments showed a significant (p < 0.01) reduction in the counts of S. aureus, S. enterica serovar Typhimurium, and E. coli O157:H7 compared to control samples. Among all tested forms and concentrations of clove, clove oil at 1.0 g/kg proved to be the most effective against the tested pathogens, as by the end of storage (day 12), it achieved 5.3 and 5.56 log reductions in S. aureus and S. enterica serovar Typhimurium, respectively, along with complete reduction in E. coli O157:H7, followed by clove extract at 1.5 g/kg, which produced 4.2, 4.92, and 7.01 log reductions in the corresponding three foodborne pathogens. The results showed that different concentrations of clove oil and extract treatments applied effectively improved the sensory attributes (flavor, tenderness, juiciness, and overall acceptability) of buffalo meatballs, while the sensory properties of clove powder were considered unacceptable, as it alters the taste and smell of meat. The ground buffalo meat treated with different concentrations of clove oil, clove extract, and clove powder significantly reduced the growth of APCs and PCs during refrigerated storage, resulting in 1.5 to 2.6 log reductions with a prolonged shelf life ranging from 9 to 12 days. Overall effects on shelf life and meat quality showed that all clove forms significantly slowed microbial growth and extended the shelf life of buffalo meatballs to 9–12 days, in contrast to 6 days or less for the control. The findings indicate that clove oil and clove extract are promising natural preservatives capable of improving microbial safety, maintaining sensory attributes, and enhancing the overall quality of buffalo meatballs during refrigerated storage. Full article

Children and adolescents with mental illness are at increased risk of developing overweight and obesity, a relationship that is complex, bidirectional, and often exacerbated by the weight-related side effects of psychotropic medications. This review addressed the research question: How are overweight and obesity addressed in children and adolescents with mental illness? Following JBI and PRISMA-ScR guidelines, a systematic search of PubMed, CINAHL, EMBASE, and PsycINFO was conducted, including studies in English or Scandinavian languages, across all designs, that focused on non-pharmacological approaches for this population aged 0–19 years. The search was completed in May 2025. Nine studies met the inclusion criteria, comprising four qualitative studies, four cohort studies, and one cross-sectional study. Based on inductive content analysis, three overarching themes were developed: approaches to weight and health, showing a predominant focus on individual lifestyle modifications; roles, resources, and prioritization, reflecting how constrained resources influence healthcare professionals’ decisions; and critical repercussions and future directions, highlighting the consequences for children, adolescents, and their families. Overall, interventions mainly target behavior change, with limited attention to structural or systemic factors. These findings underscore the need for tailored guidance and clear clinical strategies to support healthcare professionals and families in addressing weight-related issues in child and adolescent mental health care. Full article

Background/Objectives: Epilepsy is a major neurological disorder associated with significant comorbidity and treatment challenges. In low- and middle-income countries, access to newer antiseizure medications (ASMs) remains limited, and prescription patterns often rely on older agents. This study aimed to characterize national prescribing patterns of ASMs among patients with epilepsy in Kazakhstan from 2021 to 2023. Methods: We conducted a retrospective observational study using de-identified electronic health record data from the Unified National Electronic Health System of Kazakhstan. All patients with an ICD-10 diagnosis of epilepsy (G40) and at least one ASM prescription during 2021–2023 were included. Prescription frequencies, therapy type, and chronic polytherapy levels were analyzed. Associations between therapy type, age, and comorbidity status were determined. Results: A total of 54,274 patients were identified (median age 42 years; interquartile range (IQR) 31–57). Monotherapy predominated: 61.7% remained on monotherapy, 18.5% remained on polytherapy, and 19.8% had mixed exposure. Carbamazepine and valproic acid were most frequently prescribed (64.3% and 45.6% of patients, respectively). Among those with chronic medication data (n = 15,752), nervous-system drugs were common (70.1%), led by psycholeptics (49.7%); frequently dispensed agents included chlorpromazine (n = 5991), clozapine (n = 1875), and risperidone (n = 1642). Cardiovascular agents were recorded in 37.2% (acetylsalicylic acid n = 4056; atorvastatin n = 2235), and diabetes drugs in 12.1% (metformin n = 1430). Conclusions: Epilepsy treatment in Kazakhstan remains dominated by older broad-spectrum ASMs, while the use of lamotrigine and levetiracetam is steadily increasing. The frequent co-prescription of psychotropic and cardiometabolic drugs underscores the need for coordinated, multidisciplinary care and continued monitoring of prescribing patterns to enhance treatment safety and effectiveness. Full article

Background: Antidepressant medications are the cornerstone of depression treatment worldwide, playing a central role in reducing the burden of depressive disorders. Their appropriate use is particularly important in low- and middle-income countries (LMICs), where the prevalence of mental health conditions is high and health systems face increasing demand. Despite the clinical importance of antidepressants, limited evidence exists on how psychiatrists in LMICs prescribe these medications. Jordan, a middle-income country with a growing mental health burden, provides a valuable case study for understanding prescribing patterns and identifying areas for improvement. Objectives: This study examined (1) the knowledge, attitudes, and prescribing practices of Jordanian psychiatrists regarding antidepressant medications, and (2) the perceived challenges hindering optimal prescribing. Methods: A mixed-methods design was employed. Quantitatively, a cross-sectional survey was administered to licensed psychiatrists in Jordan (n = 108; response rate 79.4%). The instrument was adapted from previously published tools on psychotropic prescribing practices and refined using international guidelines and recent reviews on antidepressant use. Qualitatively, semi-structured interviews were conducted with a purposive sample of four psychiatrists to explore systemic, clinical, and contextual barriers to antidepressant prescribing. Survey data were analyzed using descriptive statistics and regression analyses, while interview transcripts were subjected to thematic analysis. Results: Although psychiatrists demonstrated a reasonable understanding of antidepressant pharmacology, important gaps were evident. Only one-third (34.3%) recognized Ministry of Health (MOH) guidelines, while nearly four in ten (37.4%) felt international guidelines did not fully apply to Jordan’s population. Laboratory monitoring for metabolic side effects was inconsistently applied, with just 17.6% always requesting such tests and 11.1% never doing so. Consultation with internal medicine for patients on multiple medications was not routine, reported as “sometimes” by 69.4% of psychiatrists. Attitudes toward prescribing reflected caution, particularly in managing pregnant or lactating women, where only half (51.0%) supported discontinuation and three-quarters (75.9%) preferred dose or drug adjustment. Early-career psychiatrists showed lower engagement, as knowledge and attitude scores were significantly higher among those with 11–20 years of experience compared to those with ≤10 years (p < 0.001). Overall, the findings highlight uneven application of evidence-based practices, reliance on personal clinical judgment, and limited engagement with national standards. Conclusions: Although safety and patient outcomes are valued, systemic, clinician, and patient-related barriers constrain optimal practice. Strengthening national guideline dissemination, ensuring medication access, and supporting continuing professional development could improve prescribing practices in Jordan and similar LMIC contexts. Full article

In recent years, the issue of drivers under the influence of medications and psychoactive substances as a cause of road accidents has gained increasing importance. This study aimed to assess the prevalence and blood concentration ranges of alcohol and psychoactive substances among drivers in northeastern Poland between 2013 and 2024. To determine the prevalence of medications and psychoactive substances in drivers’ blood, data were collected from 266 blood samples obtained from drivers (251 men and 15 women). Among these, 79 drivers died immediately, 61 drivers survived the accident, and 126 drivers were stopped for roadside checks. The presence of the studied substances was confirmed using gas chromatography combined with mass spectrometry detection (GC-MS) and liquid chromatography combined with mass spectrometry detection (LC-MS). Blood alcohol content was measured using headspace gas chromatography with a flame ionisation detector (HS-GC-FID). Psychoactive substances were detected in 152 of the 266 samples. Drivers testing positive for medications and psychoactive substances were most frequently stopped during roadside controls—67.46%. Among the total positive cases, psychoactive substances used alone or in combination included THC—46.3% (range 0.2–20 ng/mL), alcohol—26.8% (range 0.1–4.1‰), amphetamines—20.7% (range 15–2997 ng/mL), opiates—4.3% (morphine 66.0 ng/mL; methadone 174.0 ng/mL; ranges: tramadol 15.0–600.0 ng/mL; fentanyl 45.0–100.0 ng/mL), benzodiazepines—9.8% (ranges: diazepam 55.0–480.0 ng/mL; midazolam 17.0–1200.0 ng/mL; clonazepam 21.0–36.0 ng/mL), stimulants—6.10% (ranges: amphetamine 15.0–2997.0 ng/mL; cocaine 4.0–30.0 ng/mL; benzoylecgonine 38.0–602.0 ng/mL; PMMA 45.0–360.0 ng/mL; MDMA 20.0–75.0 ng/mL; mephedrone 37.5 ng/mL; alfa-PVP 120 ng/mL), psychotropic drugs—3.1% (carbamazepine 8.0–2100.0 ng/mL; zolpidem 233.0 ng/mL; citalopram 320.0 ng/mL; opipramol 220 ng/mL). The most commonly used substance among car and motorcycle drivers was THC (37.7% of car drivers and 60% of motorcyclists). Among operators of other types of vehicles, alcohol was the most frequently detected substance, present in 35% of cases. The majority of drivers (81.1%) were under the influence of a single substance. Among the drivers, 7.3% consumed alcohol in combination with at least one other substance, and 11.6% used two or more substances excluding alcohol. Among the psychoactive substances most frequently used alone or in combination with others, THC was predominant. Roadside testing, based on effects similar to alcohol intoxication, was mainly conducted on male drivers. Full article

Dry eye disease (DED) is a highly prevalent multifactorial disorder of the ocular surface that extends beyond local tear film pathology to involve systemic immune, neuroendocrine, and neurosensory mechanisms. Increasing evidence reveals a strong and bidirectional association between DED and psychiatric disorders, particularly depression, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbances. This review synthesises the current knowledge on shared molecular, neuroimmune, and neuropathic pathways that underlie this comorbidity. Key mechanisms include hypothalamic–pituitary–adrenal (HPA) axis dysregulation, systemic and ocular inflammation, oxidative stress, mitochondrial dysfunction, and impaired neurotrophic signaling, especially reduced brain-derived neurotrophic factor (BDNF). Dysregulation of monoaminergic neurotransmitters such as serotonin and norepinephrine not only contributes to mood disturbances but also alters tear secretion and corneal pain perception. Corneal nerve changes and trigeminal–limbic sensitisation further reinforce the overlap between neuropathic ocular pain and affective dysregulation. Psychotropic medications, while essential for psychiatric care, may exacerbate ocular surface dysfunction through anticholinergic effects, altered neurotransmission, and tear film instability, highlighting the iatrogenic dimension of this interface. Conversely, tear-based biomarkers, including cytokines, serotonin, and BDNF, offer promising translational tools for patient stratification, diagnosis, and treatment monitoring across ocular and psychiatric domains. Recognising DED as part of a systemic, biopsychosocial continuum is critical for effective management. Multidisciplinary strategies that integrate ophthalmologic and psychiatric care, alongside novel therapies targeting shared molecular pathways, provide a framework for improving outcomes. Future research should prioritise longitudinal studies, biomarker validation, and personalised interventions to address this complex comorbidity. Full article

Depression is becoming more common in the face of modern life’s obstacles. Antidepressants are a fast-expanding pharmaceutical category. Antidepressant residues in water must be closely monitored and kept at levels that do not endanger human health, just like those of other psychotropic medications. Additionally, research has shown that these pollutants severely hinder aquatic life’s ability to migrate, reproduce, and interact with one another when they enter natural ecosystems. Antidepressants released into the natural environment can therefore be expected to have an impact on exposed fish and other aquatic species. There is a lot of information available about how exposure affects fish, but much of it is for exposure levels higher than those seen in their natural habitats. Antidepressants can bioaccumulate in fish tissues, and some behavioral effects have been documented for exposures that are relevant to the environment. As a result, antidepressant residue removal methods must be incorporated into contemporary wastewater treatment plant technology. In addition to covering a wide range of suggested treatment options and their ecotoxicological consequences on non-target organisms, this study discusses recent efforts to accomplish this goal. First, a thorough analysis of the harmful impacts on non-target people is provided. This work describes a variety of adsorptive methods that can make use of modern materials like molecularly imprinted polymers or ion-exchange resins or can rely on well-known and efficient adsorbents like silicates or activated carbon. Although extractive methods are also taken into consideration, they are now impractical due to the lack of reasonably priced and ecologically suitable solvents. Lastly, sophisticated oxidation methods are discussed, such as electrochemical alternatives, UV and gamma radiation, and ozone therapy. Notably, some of these techniques could totally mineralize antidepressant toxicants, either alone or in combination. Lastly, the topic of biological treatment with microorganisms is covered. This method can be very specific, but it usually prevents full mineralization. Full article

Urban environmental noise represents a major public health issue contributing to chronic sleep disturbances, mainly from road, aircraft, and railway traffic. Night-time recreational noise from cafés, bars, and restaurants has emerged as a frequent source of sleep complaints but remains poorly understood, along with the influence of sociodemographic and economic factors. We addressed this gap by conducting a large-scale ecological study across the Paris Metropolitan Area (~10.5 million inhabitants) examining associations between the Average Energetic Index of night-time noise (AEI L_n) from road, aircraft, railway, and recreational sources and the prevalence of adults aged 18–79 reimbursed for hypnotic psychotropic drugs prescribed for chronic insomnia between 2017 and 2019, stratified by sex, age, and socioeconomic status. The AEI L_n represents the population-weighted average energy noise level within each territory at night (22:00–06:00 in France), calculated at the IRIS level (~2487 inhabitants per IRIS). The dispensing of hypnotic psychotropic drugs concerned 513,276 inhabitants (65.4 per 1000 inhabitants [‰]) on average per year. About 8 million inhabitants (75.7%) are exposed to night-time road traffic noise exceeding WHO health guidelines, followed by railway (~1.2 million, 11.6%), recreational (~1.2 million, 11.5%), and aircraft noise (~1.0 million, 9.8%). Each 5 dB(A) increase in AEI L_n was significantly associated (p < 0.001) with higher dispensing of hypnotic psychotropic drugs, strongest for road noise (+1.0‰), followed by recreational (+0.8‰), aircraft (+0.5‰), and railway noise (+0.3‰). Effects were significantly greater among individuals aged >50 (+8.3‰), women (+2.0‰), and those in the most socioeconomically deprived areas (+2.5‰). These results support proactive public policies aimed at reducing noise from transportation and recreational activities in densely urban areas to mitigate chronic insomnia. Full article

Background: Insomnia is markedly more prevalent in rheumatoid arthritis (RA) patients than in the general population and is closely linked to pain, fatigue, psychological comorbidities, and systemic inflammation. Evidence suggests a bidirectional relationship, where active disease worsens sleep quality, while poor sleep amplifies inflammatory activity and symptom severity. Methods: A narrative review was conducted using PubMed, Scopus, Web of Science, and Embase to identify studies from the last 15 years involving adult RA patients. Inclusion criteria required assessment of insomnia or sleep quality in relation to disease activity, treatment outcomes, or inflammatory markers. Data from clinical trials, cohort studies, and reviews were synthesized to examine prevalence, mechanisms, and therapeutic implications. Results: Insomnia affects up to 45% of RA patients and correlates with higher DAS28 scores, elevated CRP/ESR, increased pain sensitivity, and reduced quality of life. Contributing factors include chronic pain, stiffness, elevated IL-6 and TNF-α, depression, anxiety, and medication side effects. Conventional DMARDs, corticosteroids, and biologics indirectly improve sleep via inflammation control, with IL-6 inhibition showing potential sleep-specific benefits. Psychotropic agents may help in comorbid depression/anxiety but are best combined with cognitive behavioral therapy for insomnia (CBT-I). Conclusions: Insomnia is a prevalent, multifactorial problem in RA that adversely affects disease activity, symptom burden, and functional outcomes. Integrating sleep evaluation into routine RA management and adopting interdisciplinary strategies that address both inflammation and sleep disturbance may enhance patient outcomes. High-quality longitudinal studies using objective sleep measures are needed to clarify causal relationships and optimize therapy. Full article