Background Inflammatory arthritis patients experience a host of behavioral alterations that include depression, fatigue, sleep disturbances, and cognitive dysfunction. These behavioral comorbidities are apparent throughout the process of diagnosis and treatment for arthritis. Cross-sectional associations suggested a mutual impact of disease activity and psychological distress in early rheumatoid arthritis, but a prospective association has not been established.
Objectives 1. To assess both concurrent and prospective association of self-reported behavioral co-morbidities and disease activity in patients with early inflammatory arthritis; 2. To evaluate whether behavioral co-morbidities are correlated to sleep disturbance in this group of patients.
Methods 264 patients diagnosed to have early inflammatory arthritis (disease duration ≤12 months, age 21–79 years, 68% female, 32% males) were managed and monitored for 3 years on 6-monthly basis. At baseline and prior to each assessment in the clinic every patient completed a copy of the PROMs questionnaire. This included assessment for self-reported psychological functioning, sleep disturbance, functional disability, pain, fatigue score, self-helplessness and self-reported joint tenderness. Disease activity (DAS-28) was assessed at every visit. Multilevel regression analysis was applied to examine concurrent and prospective associations between disease activity and psychological distress variables. The association between behavioral comorbidities, disease activity and sleep disturbance was assessed using Pearson/Spearman correlations and multivariable linear regression.
Results Concurrent association analysis revealed five significant associations between disease activity and behavioral co-morbidity variables: (depressed mode, p<0.01; anxiety mode, p<0.02; sleep disturbance, p<0.01; pain p<0.01; and self-helplessness p<0.01) and vice versa. Prospective association analysis revealed that depressed mode, sleep disturbance as well as self-helplessness were correlated with both DAS-28 score (p<0.01) and tender joint count (p<0.01) 6 months later. Also DAS-28 was significantly correlated with depressed mode (p<0.02), anxiety mode (p<0.04), sleep disturbance (p<0.01) and self-helplessness (p<0.02) 6 months later. Multiple regression analysis confirmed that pain, depressed and anxiety modes as well as self-helplessness contributed independently and significantly to higher sleep disturbance (p<0.01).
Conclusions Among early arthritis patients, inflammation is associated with behavioral changes. Psychological distress and disease activity are positively associated when measured at the same time as well as when measured 6 months apart. A higher level of disease activity is a risk factor for an increase in behavioral co-morbidities. Also psychological distress is a risk factor for future exacerbation of disease activity. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance. The data suggest that self-reported behavioral changes is a valid tool which should be incorporated in the patients’ management in standard clinical practice. Also interventions that target pain, depression and sleep should be considered in addition to assessment of disease activity in patients with early inflammatory arthritis.
Disclosure of Interest None Declared