Background Psoriatic arthritis (PsA) is a multisystemic disease that is influenced by co morbidities, which may affect episodes of disease exacerbation and patients' quality of life. Depression and suicidal ideation may impact longevity of patients with PsA and severe psoriasis while the effect of attitude to the disease has been related to severity of psoriasis. However, studies evaluating the influence of sleep disturbances, depression, fatigue in PsA are scarce.
Objectives To evaluate the quality of sleep, fatigue, anxiety, depression in a cohort of PsA patients considering disease activity status.
Methods This was a descriptive, observational, cross-sectional study that included PsA patients diagnosed according to CASPAR criteria from a single tertiary rheumatology center during January to April 2014. PsA patients with a known psychiatric disorder were excluded. Sleep involvement was assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness scales (ESS); poor quality of sleep was considered for PSQI >5 and sleepiness for ESS ≥11. Fatigue was evaluated by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) (lower scores = worse) and anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) (higher scores = worse). PsA disease activity, functional capacity and quality of life were evaluated by DAS28, HAQ and SF-36 respectively; patients were classified in remission for DAS28<2.6 and with active disease for DAS28≥2.6.
Results A total of 29 PsA patients were evaluated, 14M:15F, mean age 51.9 ±11.1 (27-70) yrs, mean disease duration 15.3 ±12.8 (2-52) yrs. Sixteen (55%) patients were in remission and 13 (45%) had active PsA, with median HAQ scores =1.84 (0.9-2.57) and 3.24 (2.65-5.4) (p<0.0001) while mean SF-36 scores were 0.38 (0-1.38) and 0.88 (0-1.75) (p<0.003), respectively. Both patients in remission and those with active disease had altered rates of PSQI>5 (75% vs. 67%, p=0.66); EES≥11 (25% vs. 17% p=1); HAD-A scores (5 vs. 7, p=0.24) and HAD-D scores (5 vs. 4, p=0.96). Remarkably, median FACIT-F scores were worse for active compared to remission PsA patients (100 vs. 124, p=0.039).
Conclusions Fatigue is an important component of PsA, particularly for patients with active disease. In addition to altered sleep patterns, anxiety and depression levels among patients with active and inactive illness, the need of a multidisciplinary approach for the patient with PsA is mandatory. Moreover, larger studies in order to clarify the role of these conditions in the induction of disease activity are required.
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Acknowledgements Prof. Dra. Eloisa Silva Dutra de Oliveira Bonfa; Prof. Dra. Rosa Maria Rodrigues Pereira
Disclosure of Interest None declared