Background/Purpose: Sleep disturbance is a common and burdensome symptom in psoriatic arthritis (PsA), but its clinical determinants remain poorly understood. Using data from the Cohort for Psoriasis and Psoriatic Arthritis (COPPAR), we aimed to (1) compare the prevalence of sleep disturbance between patients who met Minimal Disease Activity (MDA) criteria and those who did not, and (2) identify clinical and patient-reported factors associated with sleep disturbance.

Methods: This cross-sectional study included patients with PsA enrolled in COPPAR. The primary outcome was the sleep item from the PsAID-9 questionnaire (0–10 scale). We compared the prevalence of clinically meaningful sleep disturbance (defined as PsAID sleep score > 4) between patients in MDA and those not in MDA using chi-square tests. We evaluated predictors using a general linear model (GLM) for the continuous PsAID sleep score. The initial models included age, sex, pain, itch, PHQ-8, FACIT fatigue, PROMIS anxiety, skin and joint global assessments, DLQI, MDHAQ, enthesitis score, tender/swollen joint counts, and topical treatment use. Sleep disorder diagnosis was added in sensitivity analysis.

Results: Among 204 patients with PsA, 112 (54.9%) were female, and 191 (93.6%) identified as White. MDA was achieved by 101 participants (49.5%). A diagnosis of sleep disorder was reported in 36 participants (17.6%). Most (n = 173, 84.8%) were on biologic, targeted synthetic, or conventional systemic therapy, and 111 (55%) used topical agents. Among those in MDA, 9 (8.9%) reported a PsAID-9 sleep score > 4, compared to 37 (35.9%) among those not in MDA. PsAID-9 sleep scores were significantly associated with MDA status (χ² = 20.53, p < 0.0001).In the primary GLM (R² = 0.52), pain severity (β = 0.47, p < 0.0001) was the strongest independent predictor of worse sleep. Greater itch (β = 0.25, p = 0.0003) and fatigue (lower FACIT; β = –0.09, p < 0.0001) were also significantly associated with worse sleep. Current topical agent use was associated with better sleep (β = –0.60, p = 0.039). PHQ-8 score was not retained in the final model.In the sensitivity model (R² = 0.55), sleep disorder diagnosis was independently associated with worse sleep (β = 0.90, p = 0.013). Pain (β = 0.46, p < 0.0001), itch (β = 0.24, p = 0.0007), fatigue (β = –0.05, p = 0.0287), and PHQ-8 score (β = 0.11, p = 0.0498) were also independently associated with worse sleep. Topical treatment use remained protective (β = –0.64, p = 0.024).

Conclusion: Patients in MDA were significantly less likely to report clinically meaningful sleep disturbance. In multivariable models, worse sleep was consistently associated with higher pain, greater itch, and more fatigue. Longitudinal studies are needed to better understand temporal relationships and inform targeted sleep interventions in PsA.

NRS, Numerical Rating Scale

All estimates are from a fully adjusted model.

Beta coefficients represent the mean change in PsAID-9 sleep score per unit increase in the predictor (or the difference in means for binary predictors).

*Age and sex were retained in all models regardless of statistical significance

NRS, Numerical Rating Scale

All estimates are from a fully adjusted sensitivity model including sleep disorder diagnosis.

Beta coefficients represent the mean change in PsAID-9 sleep score per unit increase in the predictor (or the difference in means for binary predictors).

*Age and sex were retained in all models regardless of statistical significance

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbance-in-psoriatic-arthritis-prevalence-by-minimal-disease-activity-status-and-associated-clinical-factors/