Background Rheumatoid arthritis (RA)as one of the most common autoimmune diseases is known to be one of the leading causes of disability.Sleep disorders have direct influence on patient's life. But the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood.
Objectives The aim of our study is to evaluate the impact of RA in sleep quality and to establish associated factors.
Methods This is a cross-sectional and descriptive study during a period of the year 2016, including 37 patients followed in the department of Rheumatology in Mahdia Tunisia. All patients were diagnosed with RA based on ACR 1987/EULAR2010. We evaluated for each patient the parameters of activity of the disease, the quality of life by the HAQ questionnaire and the quality of sleep using two scales: Epworth (ESS) and Pittsburg scale (PSQI) which is composed from 7 components rated each one from 0 to 3.
Results The age of the RA patients (32 females/5 males) ranged from 21 to 76 years. The mean age was 53.1±12 years. The mean duration of the disease was 11±10 years [1–34]. The mean number of tender joints was 13.2±9.6 and swollen joint was 5.9±7. The mean DAS28 was 5.5±1.5 [2.9–8.2] and HAQ was 1.6±0.9 [0–2.8]. 51.3% of patients had specific joint deformations, 83.8% had radiologic involvement and 29.7% had osteoporosis.
The biologic analysis showed that the mean ESR was 45±27.1 and the CRP was 13.7±25.3. Rheumatoid factors were positive in 37.8% of cases, the ACPA were positive in 32.4% of cases. 81.1% of RA patients were treated by methotrexate and 13.5% were treated by biologic treatments.
The mean Epworth score was 9±5.7 (0–23). 56.8% of patients had no sleep debt, 32.4% had a sleep deficit and only 10.8% had signs of somnolence. Our study confirmed a significant correlation between the Epwoeth score and the number of tender joints, the ESR, the Health assessment quality (HAQ) score.
Regarding the overall score of Pitsburg, the average was 8.4±4.1 (1–16). The average of the “subjective sleep quality” was 1.35, “latency to sleep” was 1.81, “sleep duration” was 1.24, “habitual sleep efficiency” was 1.08, “sleep disorders” was 1.62, “the use of a sleep medicine” was 0.27 and finally the average of the 7th component about “poor form during the day” was 1.11 out of 3. So the latency to sleep and sleep disorders were the most affected components. We had a significant correlation between PSQI and the number of swollen joints, the HAQ score. The value of the ACPA was found to be associated with high score of PSQI.
Conclusions Our study showed that the sleep disruption wasn't rare in patients with RA. This can be related to the disability and pain caused by this disease. Further studies with large sample size, as well as more careful tools of sleep disorders, would help to generalize results and suggestions. By providing adequate health care, and recognition of the patients' pain conditions we would ameliorate sleep quality and increase the QOL of RA patients.
Majid Purabdollah, et al, Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis; Journal of Caring Sciences, 2015, 4(3), 233–241.
Seda PEHLİVAN et al, Sleep quality and factors affecting sleep in elderly patients with rheumatoid arthritis in Turkey; Turk J Med Sci (2016) 46: 1114–1121.
Disclosure of Interest None declared