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In response to SASP, macrophages are recruited into the articular space and secrete proinflammatory factors to activate synovial fibroblasts, which promote osteophyte formation and further exacerbating osteoarthritis [140]

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The most common reasons are a small overnight glucose dip with cortisol surge (fix: a protein-fat snack before bed), nighttime reflux (fix: earlier dinner and bed-head elevation), or a vivid-dream wake-up (usually self-limiting by week 8)