Poor Sleep Increased Rheumatoid Arthritis Symptoms in Psoriatic Arthritis Patients, finds study

A recent nationwide study from Finland elucidated the significant association between poor sleep quality, comorbidities and heightened symptom levels in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The key findings of this study were published in the Joint Bone Spine journal.

The research drew extensive data from The Finnish Rheumatology Quality Register and highlighted the crucial impact of sleep quality on patient-reported outcomes (PROs) such as pain, global assessment and fatigue. The study utilized clinical data collected between January 2021 and September 2022. The self-reported sleep quality was categorized into two groups, where the “good” sleep indicated little or no difficulties and the “poor” sleep signified great difficulties or inability to sleep. The research also incorporated data on comorbidities from national registers by applying descriptive statistics and regression analyses to explore the independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA patients, while adjusting for age and sex.

Among the 13,512 patients with RA, 6,052 (mean age 62, 71% female) had their sleep status reported. In the PsA group, 1,861 out of the 3,636 patients (mean age 55, 48% female) provided sleep data. In the RA cohort, 5,072 patients (84%) reported good sleep, while 980 (16%) underwent poor sleep. Also, in the PsA group, 1,460 patients (78%) reported good sleep and 401 (22%) reported poor sleep.

The study found that median values for objective disease activity were low and comparable between patients with poor and good sleep in both RA and PsA groups. Among the patients with no swollen joints, the median values for PROs were approximately three times higher in the individuals with poor sleep when compared to the individuals with good sleep, in both diseases. This difference was statistically significant (p<0.001).

The regression analyses revealed that poor sleep was independently associated with higher pain levels. In RA, the pain score elevated by 20 points (95% CI 18-22) and in PsA, it increased by 23 points (95% CI 19-26) for patients reporting poor sleep. Also, comorbid fibromyalgia emerged to be a significant factor by contributing to increased pain in both RA and PsA. Depression was markedly associated with higher pain levels in RA, while sleep apnea was a significant comorbidity in PsA.

The study illuminates the importance of considering sleep quality in the management of RA and PsA for the patients expressing severe symptoms without corresponding objective disease activity. Poor sleep quality and comorbidities like fibromyalgia, depression and sleep apnea independently contribute to elevated pain and overall symptom burden.

Source:

Weman, L., Salo, H., Kuusalo, L., Huhtakangas, J., Vähäsalo, P., Backström, M., Kärki, J., & Sokka-Isler, T. (2024). Intense symptoms of pain are associated with poor sleep, fibromyalgia, depression and sleep apnea in patients with rheumatoid arthritis and psoriatic arthritis. A register based study. In Joint Bone Spine (p. 105744). Elsevier BV. https://doi.org/10.1016/j.jbspin.2024.105744