Background/Purpose: The impact that sleep has on patients’ perception of disease activity in Psoriatic Arthritis (PsA) has been poorly understood. We assessed the association between sleep, as measured with a 21-point VAS, and various measures of disease activity.

Methods: All patients seen in the clinic of MB are asked to complete a questionnaire (MDHAQ) with additional questions regarding sleep, as part of the routine care in this practice. After a clinical exam, including a 28 tender (TJC) and swollen (SJC) joint count, the physician records an MDGlobal score, using a 21 point VAS (0-10). From these values, the RAPID3 (a composite score of Pt Pain+PtGlobal+Function) is calculated. Additionally, the CDAI can also be calculated (TJC+SJC+PtGlobal+MDGlobal). While neither measure has been extensively studied in PsA, they provide insight into the levels of disease activity as perceived by the patient and by the treating physician. We performed multiple regressions, using the Sleep VAS as the dependent variable, to investigate its impact on the various independent variables and composite scores.

Results: Random visits of 49 patients (45% male, mean age=59.36yrs, mean disease duration=6.63yrs, mean Sleep VAS=3.83)) were included for study. Multiple regressions were performed “controlling for” age, sex and disease duration. Based on our results, Sleep VAS has a significant impact on TJC, Pain and PtGlobal scores (p<0.05),with a trend toward significance for SJC (p=0.058) (Table1). The composite scores were also significantly impacted: RAPID3 (p=0.018) and CDAI (p=0.003). When the PtGlobal score is removed from the CDAI (“C3”=TJC+SJC+MDGlobal), the significance remained (p=0.014), suggesting that the impact of sleep was not only observed by the patient, but also by the treating physician.

Conclusion: Patients with PsA often report difficulty with sleep. We demonstrate a strong association between patient reported sleep problems and multiple measures of disease activity. While it might be assumed that this association would impact patient reported outcomes (PROs), there is also a strong association between sleep and physician measures, including the CDAI. While neither the RAPID3 nor CDAI have been validated for the monitoring of PsA, we feel that this study provides insight into the impact of sleep on disease activity. Based on this study, one cannot determine whether sleep disturbances influence disease activity or vice versa. Nevertheless, by monitoring a Sleep VAS, one can accurately assess levels of disease activity in PsA patients.

Figure 1

Sleep VAS=dependent variable C3=TJC+MDGlobal

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-sleep-on-measures-of-disease-activity-in-psoriatic-arthritis/