Background/Purpose: Psoriasis is a chronic inflammatory skin disease characterized by scaling, erythematous plaques. Up to 30% of psoriasis patients develop an inflammatory arthritis termed psoriatic arthritis (PsA). Psoriatic disease (PsD) patients report impaired sleep quality, but the relationship between sleep quality and disease and demographic factors has not been examined. This study aimed to determine and compare the prevalence and quality of sleep disturbance in patients with PsA and patients with psoriasis without arthritis (PsC), and to identify associated disease-related and demographic factors.

Methods: The study included 113 PsA (CASPAR criteria) and 62 PsC (evaluated by a rheumatologist to exclude PsA) patients (mean age 57.4±11.6 and 56.9±14.2 years, men 55% and 40%, disease duration 17.1±11.6 and 25.9±17.0 years, respectively), and 52 healthy controls (mean age 42.2±13.6, men 29%). Clinical variables were collected using a standard protocol. The sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Other patient reported outcomes collected included the Health Assessment Questionnaire (HAQ), Dermatology Quality Life Index (DLQI), EQ-5D, Medical Outcome Study Survey (SF-36), patient global assessment (PGA) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT) Scale. Statistical analysis includes descriptive statistics, Wilcoxon rank-sum test and linear regression.

Results: The prevalence of poor sleep quality was 84% (95/113), 69% (43/62), 50% (26/52) in PsA, PsC and healthy controls, respectively. Total PSQI score was higher in both PsA and PsC patients compared to healthy controls (9.24 and 7.18 vs. 5.67, p<0.01) and higher in PsA patients compared to PsC patients (9.24 vs 7.18, p<0.0001). PSQI components of sleep disturbances, latency, daytime dysfunction, and subjective sleep quality contributed to worse sleep quality in PsA patients compared to PsC patients (p<0.01). Controlling for sex and group, anxiety, EQ-5D and FACIT were independently associated with worse PSQI in PsC and PsA patients (p<0.05). Controlling for age, sex, and BMI, actively inflamed (tender or swollen) joints were independently associated with worse PSQI in PsA patients (p<0.01).

Conclusion: Patients with PsD have poor sleep quality, especially in those with PsA. Poor sleep is associated with fatigue, anxiety, and lower EQ-5D in patients with PsD. In patients with PsA, poor sleep is associated with active joint inflammation. . However, given this was a cross-sectional study, whether anxiety and lower EQ-5D are the causes or the consequences of poor sleep remains to be determined.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sleep-disturbance-in-psoriatic-disease-prevalence-and-associated-factors/