Background/Purpose: Rheumatoid arthritis is a chronic inflammatory disease affecting mainly diartrodial synovial joints. Fatigue and sleep disturbances are commonly seen symptoms in RA patients  which are related to both inflammation and psychosocial factors.  To evaluate the relation between fatigue and sleep disturbances together with clinical, functional and quality of life measures in RA patients.

Methods: Subjects  fulfilling ACR 1987 revised criteria were consecutively recruited into the study. Patients with malignancy, fibromyalgia syndrome other systemic inflammatory diseases were excluded. Demographic, clinical, functional, laboratory, radiographic data of patients was recorded. The body mass index (BMI), severity of pain (VAS), severity of fatigue (VAS), disease duration (month) was evaluated. Disease activity, functional status and quality of life were assessed respectively with DAS 28, Duruöz Hand Index (DHI), Hand Functional Index (HFI), SF-36 and Rheumatoid arthritis quality of life (RAQOL) Pittsburgh Sleep Quality Index (PSQI) were used to measure patients’ quality of sleep.  Statistical analyses were performed with Pearson correlation coefficient and a value of p <0.05 was considered as statistically significant.

Results: Seventy patients (22 male) were recruited into the study. The mean of age 54,12±12,25 and the mean disease duration was 85,67 ± 95,79  months. The patient scores (mean ± SD) were: VAS severity of pain: 36,51±26,31 (mm), VAS severity of fatigue: 36,31±25,65 (mm), DAS 28: 4,27±1,49, DHI:12,67±14,37, HFI: 13,63±9,72, SF-36 vitality score: 47,06±22,39, RAQOL: 12,83±8,42,  PSQI : 6,25±3,52. PSQI and VAS severity of fatigue showed significantly positive correlation with RAQOL (r= 0,417, p<0,001) (r= 0,577, p<0,001)  and significantly negative correlation with SF-36 vitality subscale (r= -0,565, p<0,001) (r= -0,442, p<0,001) respectively. There was a weak but significant correlation between PSQI and VAS severity of fatigue (r= 0,281, p=0, 02).  PSQI showed no significant correlation with various demographic, clinical and laboratory features like age (p=0,904) disease duration (p=0,193), DAS 28 (p=0,812), VAS pain(p=0,309), DHI (p=0,415), HFI (p=0,074), ESR (p=0,507), CRP (p=0,693) (p>0,05). 

Conclusion: Our findings confirmed that degree of fatigue and  sleep quality of RA patients are mostly related with quality of life and vitality. Disease activity, laboratory parameters or functional status of patients are not significantly correlated with sleep quality. So treatment strategies that only target inflammation are not enough. Sleep disturbances and psychological factors should be evaluated separately.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-sleep-quality-in-patients-with-rheumatoid-arthritis/