Pain and Anxiety Are Independent Factors Associated to Sleep Impairment in Psoriatic Arthritis: A Multicentric Study in 14 Countries

Penelope Palominos¹, Laura Coates ², Charles Kohem ³, Ana-Maria Orbai ⁴, Josef Smolen ⁵, Maarten de Wit ⁶, Uta Kiltz ⁷, Ying-Ying Leung ⁸, Juan Cañete ⁹, Rossana Scrivo ¹⁰, Andra Balanescu ¹¹, Emmanuelle Dernis ¹², Sandra Talli ¹³, Martin SOUBRIER ¹⁴, Sibel Zehra Aydin ¹⁵, Inna Gaydukova ¹⁶, Umut Kalyoncu ¹⁷ and Laure Gossec ¹⁸, ¹Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul,, Porto Alegra, Brazil, ²University of Oxford, Oxford, United Kingdom, ³Serviço de Reumatologia, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ⁴Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, Baltimore Maryland, ⁵Medical University of Vienna, Vienna, Austria, ⁶Department of Medical Humanities, Amsterdam Public Health (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands, ⁷Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany, Herne, Germany, ⁸Department of Rheumatology and Immunology, Singapore General Hospital,, Singapore, Singapore, ⁹Department of Rheumatology, Hospital Clínic, Barcelona, Barcelona, Spain, ¹⁰Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza Università di Roma,, Rome, Italy, ¹¹Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania, ¹²Rheumatology Department, Le Mans Central Hospital, Le Mans, France, ¹³Rheumatology Department, East-Tallinn Central Hospital, Tallinn, Estonia, ¹⁴CHU Gabriel Montpied, Clermont Ferrand, Auvergne, France, ¹⁵University of Ottawa Faculty of Medicine, Rheumatology,Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, CANADA, Ottawa, Canada, ¹⁶North-western State medical university, St Petersburg, Russia, ¹⁷Hacettepe University Department of Rheumatology, Ankara, Turkey, ¹⁸Sorbonne Université and Hôpital Pitié-Salpêtrière, Paris, France

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Psoriatic arthritis, quality of life and sleep disorders, sleep

Session Information

Date: Tuesday, November 12, 2019

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Psoriatic Arthritis, Clinical Features

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Sleep quality is diminished in patients with psoriatic arthritis (PsA) and close to 40% of PsA patients consider sleep impairment a priority domain.This work analyzed determinants of impaired sleep in patients with PsA.

Methods: This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805), which included adult patients with definite PsA with ≥ 2 years disease duration from 14 countries (ref 1). Sleep was assessed using the patient self-reported evaluation of sleep on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12) (ref 2). A score ≥ 4 was considered as sleep impairment. Demographic and clinical variables associated to sleep impairment were assessed through univariate analysis; prevalence ratios (PR)[95% CI] were reported. Variables independently associated to sleep impairment in the univariate analysis (with p-value < 0.05) were entered in the Poisson regression model.

Results: A total of 396 patients were analyzed: mean age 51.9 ± 12.6, 51% (N= 202) were females, 59.7% were receiving biologic therapy (N= 221), 53.3% (N=201) of participants had 1-5% of body surface area (BSA) affected by psoriasis, 74% (N=293) had mild disability (defined as a score ≤1 in the Health Assessment Questionnaire-HAQ); 23.7% (N=94) were in remission and 36.9% (N=146) in low disease activity according to the Disease Activity in Psoriatic Arthritis (DAPSA) score. Median (25th-75th) patient’s self-evaluation of sleep difficulties was 2 (0-6), 39.9% (N=158) were considered as having sleep impairment. In the univariate analysis, factors independently associated to sleep impairment were: moderate (HAQ >1 to 2) and severe (HAQ >2 to 3) disability (PR: 1.55 [1.39-1.72] and 2.07 [1.97-2.18] respectively, p< 0.001), glucocorticoid use (PR: 1.52 [1.16-1.99], p=0.003), obesity (PR: 1.50 [1.06-2.11], p=0.021), psoriasis affecting >20% of BSA (PR: 1.12 [1.08-1.17], p< 0.001), moderate and high disease activity by DAPSA (PR: 7.01 [3.54-13.8] and 8.71 [4.46-17.9] respectively, p< 0.001) and self-reported levels of anxiety, depression and fatigue (PR: 1.22 [1.18-1.28], 1.16 [1.14-1.21] and 1.28 [1.23-1.33] respectively, p< 0.001). Poisson regression model showed only self-reported levels of anxiety (PR: 1.05 [1.02-1.08], p=0.003) and the pain component of DAPSA (PR: 1.06 [1.01-1.09], p< 0.001) contributing to sleep impairment (Table 1).

Conclusion: Sleep impairment was frequent in this population of PsA patients; pain and anxiety were independently associated to sleep impairment.

Table 1 ACR 2019

Disclosure: P. Palominos, None; L. Coates, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Prothena, Sun Pharma, UCB, 5, Abbvie, Amgen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, 5, Abbvie, Amgen, Lilly, Novartis, Pfizer, UCB, 8, AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, UCB, 8, AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer, 2, AbbVie, Celgene Corporation, Novartis, Pfizer, 2, Abbvie, Celgene, Novartis, Pfizer, Lilly, 2, Amgen, 5, 8, Biogen, 8, Bristol-Myers Squibb, 5, Celgene, 2, 5, 8, Eli Lilly, 2, 5, 8, Galapagos, 5, Gilead, 5, Janssen, 2, 5, 8, Janssen Research & Development, LLC, Lilly, 2, 5, 8, MSD, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 2, 5, 8, Prothena, 5, Sun Pharma, 5, UCB, 5, 8, UCB Pharma, 5; C. Kohem, None; A. Orbai, None; J. Smolen, AbbVie, 2, 5, 8, Abbvie, 2, 5, Amgen, 5, 8, AstraZeneca, 2, 5, 8, Astra-Zeneca, 5, Astro, 5, 8, BMS, 5, Celgene, 5, 8, Celltrion, 5, Celtrion, 5, 8, Chugai, 5, Eli Lilly and Company, 2, 5, Gilead, 5, GlaxoSmithKline, 5, 8, ILTOO, 5, 8, ILTOO Janssen, 5, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Medimmune, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, Novartis- Sandoz, 5, Novartis-Sandoz, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 5, Roche, 2, 5, Roche;, 2, 5, 8, Samsung, 5, 8, Sanofi, 5, 8, Sanofi-Aventis, 5, UCB, 5, 8; M. de Wit, Abbvie, 5, 8, BMS, 5, 8, Celgene, 5, 8, Eli Lilly, 5, 8, Janssen-Cilag, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8; U. Kiltz, AbbVie, 2, 5, 8, ABBVIE, NOVARTIS, CHUGAI, JANSEN, MSD, UCB, 8, ABBVIE, NOVARTIS, LILLY,BIOCAD, GRUNENTHAL,UCB, 5, ABBVIE, NOVARTIS, PFIZER,BIOGEN, 2, Biocad, 2, 5, Biogen, 2, 5, Chugai, 2, 5, 8, Eli Lilly, 2, 5, Eli Lilly and Company, 5, Grünenthal, 2, 5, 8, Janssen, 8, Jasnssen, 2, 5, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, Roche, 2, 5, 8, UCB, 2, 5, 8; Y. Leung, None; J. Cañete, Eli Lilly and Company, 5, Janssen, 5, 8, Novartis, 5, 8, Mylan, 5, Pfizer, 5, UCB, 5; R. Scrivo, None; A. Balanescu, None; E. Dernis, None; S. Talli, None; M. SOUBRIER, None; S. Aydin, None; I. Gaydukova, None; U. Kalyoncu, UCB, 5; L. Gossec, Abbvie, 5, AbbVie, 5, Abbvie, Biogen, BMS, Celgene, Lilly, Novartis, Pfizer, SAnofi-Aventis, UCB, 5, Amgen, 5, Biogen, 5, BMS, 2, 5, Celgene, 5, Celgene Corporation, 2, Janssen, 5, Lilly, 2, 5, MSD, 5, Nordic Pharma, 5, Novartis, 5, Pfizer, 2, 5, Sanofi, 5, Sanofi-Aventis, 5, UCB, 5.

To cite this abstract in AMA style:

Palominos P, Coates L, Kohem C, Orbai A, Smolen J, de Wit M, Kiltz U, Leung Y, Cañete J, Scrivo R, Balanescu A, Dernis E, Talli S, SOUBRIER M, Aydin S, Gaydukova I, Kalyoncu U, Gossec L. Pain and Anxiety Are Independent Factors Associated to Sleep Impairment in Psoriatic Arthritis: A Multicentric Study in 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/pain-and-anxiety-are-independent-factors-associated-to-sleep-impairment-in-psoriatic-arthritis-a-multicentric-study-in-14-countries/. Accessed November 12, 2019.

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