Background Rheumatoid arthritis (RA) is the most common chronic inflammatory disease that affects about 1% of the population, and it is characterized by polyarthritis and widespread systemic manifestations [1]. Fatigue, sleep disturbances and depression are constitutional features of RA and lead to increased comorbidities and impaired quality of life [2, 3]. An effect and contribution of these factors to RA disease status has been suggested with possible improvement of the disease outcome after their targeted treatment.

Objectives To determine the prevalence of fatigue, poor sleep quality and mood disturbance in RA patients and evaluate their relation to disease activity and hemoglobin level. As well to investigate the contribution of fatigue, poor sleep quality and mood disturbance to RA activity status.

Methods This is a cross-sectional study that was approved by our local ethical committee. A total of 115 RA patients diagnosed according to the 2010 ACR-EULAR Classification Criteria for RA were enrolled in the study. Disease activity was measured using Disease Activity Score for 28 joints (DAS-28). Fatigue using the Global Fatigue Index (GFI) [4], sleep disturbances using the Pittsburgh Sleep Quality Index (PSQI) [3] and depression using Beck Depression Inventory (BDI) [5] were measured for all RA patients.

Results Fatigue was detected in 87.8% of RA patients, with mean GFI score was 27.9. Patients' sleep quality and mood status were affected with 54.8% have a poor sleep quality, and 29.6% have moderate to severe depression.

Fatigue, poor sleep quality and depression are positively correlated with the DAS-28 (r=0.407, p<0.001), (r=0.333, p=0.001) and (r=0.290, p=0.002) respectively. Hemoglobin level was inversely correlated with DAS-28 (r=- 0.384, p=0.001) and with PSQI (r=-0.210, p=0.031).

Multiple regression analysis between DAS-28 and GFI, PSQI and BDI showed that the 3 variables contributed up to 17.6% of the DAS-28 score with the strongest correlates were fatigue, followed by poor sleep quality and depression respectively.

Conclusions Fatigue, poor sleep quality and depression were prevalent in RA patients and they are directly correlated with disease activity. Also, anemia were correlated with disease activity and poor sleep quality.

The results of our study highlighted the contribution of fatigue, depression and poor sleep quality in RA disease activity status. Assessments of these parameters in clinical practice, and their appropriate management need to be applied to improve disease outcome.

References

1. Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012 Dec;18(13 Suppl):S295-302.

2. Nikolaus, S., et al., Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis care & research, 2013. 65(7): p. 1128-1146.

3. Westhovens, R., et al., Sleep problems in patients with rheumatoid arthritis. The Journal of rheumatology, 2014. 41(1): p. 31-40.

4. Hewlett, S., et al., Measures of Fatigue. Arthritis Care & Research, 63, No. S11, November 2011, pp S263–S286.

5. Beck, A., et al., An inventory for measuring depression. Arch Gen Psychiatry.1961;4:561-571.

Disclosure of Interest None declared