Background Patients with rheumatoid arthritis (RA) suffer from not only pain but also sleep disturbance and depression. However, in the previous study, there was less data about quality of sleep (QOS), quality of life (QOL), and depression in RA patients.
Objectives In this study, we aimed to assess the impact of RA on QOS comparing it with that of control subjects. We also studied the relationship between QOS, QOL, and depression according to disease activity and by using TNF-alpha blocker.
Methods 130 patients with RA and 117 voluntary control subjects participated in the study. The groups were compared in terms of demographic characteristics. In the RA patients, disease activity score-28 joint count (in DAS-28, a below 3.2 score indicates a low disease activity group and above 3.2 indicates a moderate to high disease activity group), use of TNF-alpha blocker, and dose of methotrexate (MTX) were checked. QOS was evaluated by using the PSQI (Pittsburgh Sleep Quality Index) Health Survey in all the study participants. BDI (Beck Depression Inventory) was used to evaluate depression and QOL was estimated by using Korean versions of the SF-36 (Short Form 36) in the RA patients.
Results The subjective sleep quality, sleep latency, habitual sleep efficiency, sleep duration, use of sleeping medication, and total PSQI score were higher in RA than control subjects (p<0.05). The low disease activity group had significantly scored low in subjective sleep quality, sleep duration, sleep disturbance, and total PSQI than moderate to high disease activity group (p<0.05). The BDI score was significantly lower in the low disease activity group (p<0.05). The total SF-36 score and MTX dose (mg/wk) were high in low disease activity group than moderate to high disease activity group (65.23±19.83 vs. 55.34±20.72, respectively, p<0.01; 8.95±5.19 vs. 6.25±5.12, respectively, p<0.01). But there was no significant difference in the dose of PDN, number of DMARDs used, BMI, and disease duration between the two groups. There were seventeen patients who used TNF blocker. There was no significant association with PSQI, total SF-36, and BDI scores between the TNF blocker using group and the non-TNF blocker using group, respectively. The DAS 28 score correlated with the PSQI, total SF-36, and BDI score in RA patients (p<0.01).
Conclusions Considering the results, we need to recognize that the patients with RA suffer from sleep disturbance and depression, and their disease activity is associated with QOS, QOL, and depression. Appropriate disease control of RA could lead to improve their QOS and QOL.
Wells GA, Li T, Kirwan JR, et al. Assessing quality of sleep in patients with rheumatoid arthritis. J Rheumatol 2009;36:2077-86.
Wolfe F, Michaud K, Li T. Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales. J Rheumatol 2006;33:1942-51.
Birtane M, Uzunca K, Tastekin N, Tuna H. The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey. Clin Rheumatol 2007;26:679-84.
Melikoglu MA, Melikoglu M. The relationship between disease activity and depression in patients with Behcet disease and rheumatoid arthritis. Rheumatol Int 2010:30:941-6
Disclosure of Interest None Declared