scholarly journals Sleep problems in rheumatoid arthritis over 12 years from diagnosis: results from the Swedish EIRA study

RMD Open ◽  
2022 ◽  
Vol 8 (1) ◽  
pp. e001800
Author(s):  
Lauren Lyne ◽  
Torbjörn Åkerstedt ◽  
Lars Alfredsson ◽  
Tiina Lehtonen ◽  
Saedis Saevarsdottir ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sleep Quality ◽  
Functional Impairment ◽  
Disease Duration ◽  
Sleep Problems ◽  
Health Assessment ◽  
Current Treatment ◽  
Newly Diagnosed ◽  
Time In Bed ◽  
Restorative Sleep

ObjectiveMost studies of rheumatoid arthritis (RA) and sleep have focused on established RA. We here investigate sleep quality and sleep duration in patients with newly diagnosed RA and during 1–12 years after diagnosis.MethodsData were collected on sleep 1–12 years after diagnosis from patients diagnosed 1998–2018 in the Swedish study Epidemiological Investigation of RA. Six sleep domains (sleep problems, non-restorative sleep, insomnia, insufficient sleep, sleep quality perceived as poor and sleep considered a health problem); a global sleep score and time spent in bed were estimated. Using logistic regression, ORs were calculated for each sleep outcome by disease duration. We explored whether pain (low (Visual Analogue Scale=0–20 mm, reference), intermediate=21–70, high=71–100) or functional impairment (Health Assessment Questionnaire>1.0) was associated with problems.ResultsWe had sleep data on 4131 observations (n=3265 individuals). Problems with ≥1 sleep domain (global sleep score) was reported in 1578 observations (38%) and increased with disease duration (OR 1.04, 95% CI 1.02 to 1.07). Median time in bed was 8 hours (Q1-Q3: 7.5–9.0). High-grade pain increased the likelihood of sleep problems ~3–9 fold, and increased functional impairment ~4–8 fold.ConclusionIn this cohort of newly diagnosed patients with RA with access to the current treatment from diagnosis, we did not find any major problems with sleep, and existing sleep problems related mainly to pain and reduced function. Treatment of sleep problems in RA should be guided towards treating the underlying problem causing the sleep disturbance.

scholarly journals RA disease impact in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society

2021 ◽  
Author(s):  
Elena Nikiphorou ◽  
Hannah Jacklin ◽  
Ailsa Bosworth ◽  
Clare Jacklin ◽  
Patrick Kiely
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Duration ◽  
Sleep Problems ◽  
Current Treatment ◽  
Advanced Therapies ◽  
Patient Reported ◽  
On Line ◽  
Patient Reported Measures ◽  
Daily Physical Activities ◽  
High Range

Abstract Objectives To reveal the everyday impact of living with RA in people not treated with advanced therapies; biologic or targeted synthetic disease modifying anti-rheumatic drugs. Methods People with RA, disease duration more than 2 years, not currently treated with advanced therapies, completed an on-line survey promoted by the National Rheumatoid Arthritis Society. Items covered demographics, current treatment, RA flare frequency, the Rheumatoid Arthritis Impact of Disease (RAID) tool and questions reflecting work status and ability. Descriptive and multivariable regression analyses were performed. Results There were 612 responses, mean age 59 years, 88% female, disease duration 2– 5 years 37.7%, 5–10 years 27.9%. In the last year 90% reported an RA flare, >6 flares in 23%. A RAID ‘patient acceptable state’ was recorded in 12.4%. Each of the seven domains were scored in the high range by > 50% respondents. 74.3% scored sleep problems and 72% fatigue in the high range. A need to change working h was reported by 70%. Multivariable analyses revealed increasing difficulties with daily physical activities, reduced emotional and physical wellbeing in the past week were all significantly associated with pain, number of flares and ability to cope (p < 0.005). The RAID score was significantly predictive of the number of flares. Conclusions Patients not currently treated with advanced therapies experience profound difficulties in everyday living with RA, across a broad range of measures. We advocate that patient reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life.

scholarly journals POS1465-HPR THE RELATIONSHIP BETWEEN SEDENTARY BEHAVIOR AND SLEEP IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1017.2-1018
Author(s):  
N. Kelly ◽  
E. Hawkins ◽  
H. O’leary ◽  
K. Quinn ◽  
G. Murphy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Sleep Quality ◽  
Sedentary Behavior ◽  
Disease Duration ◽  
Cross Sectional Study ◽  
P Value ◽  
Poor Sleep ◽  
Cross Sectional ◽  
The Relationship

Background:Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory condition that affects 0.5% of the adult population worldwide (1). Sedentary behavior (SB) is any waking behavior characterized by an energy expenditure of ≤1.5 METs (metabolic equivalent) and a sitting or reclining posture, e.g. computer use (2) and has a negative impact on health in the RA population (3). Sleep is an important health behavior, but sleep quality is an issue for people living with RA (4, 5). Poor sleep quality is associated with low levels of physical activity in RA (4) however the association between SB and sleep in people who have RA has not been examined previously.Objectives:The aim of this study was to investigate the relationship between SB and sleep in people who have RA.Methods:A cross-sectional study was conducted. Patients were recruited from rheumatology clinics in a large acute public hospital serving a mix of urban and rural populations. Inclusion criteria were diagnosis of RA by a rheumatologist according to the American College of Rheumatology criteria age ≥ 18 and ≤ 80 years; ability to mobilize independently or aided by a stick; and to understand written and spoken English. Demographic data on age, gender, disease duration and medication were recorded. Pain and fatigue were measured by the Visual Analogue Scale (VAS), anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index. SB was measured using the ActivPAL4™ activity monitor, over a 7-day wear period. Descriptive statistics were calculated to describe participant characteristics. Relationships between clinical characteristics and SB were examined using Pearson’s correlation coefficients and regression analyses.Results:N=76 participants enrolled in the study with valid data provided by N=72 participants. Mean age of participants was 61.5years (SD10.6) and the majority 63% (n = 47) were female. Participant mean disease duration was 17.8years (SD10.9). Mean SB time was 533.7 (SD100.1) minutes (8.9 hours per day/59.9% of waking hours). Mean sleep quality score was 7.2 (SD5.0) (Table 1). Correlation analysis and regression analysis found no significant correlation between sleep quality and SB variables. Regression analysis demonstrated positive statistical associations for SB time and body mass index (p-value=0.03846, R2 = 0.05143), SB time and pain VAS (p-value=0.009261, R2 = 0.07987), SB time and HADS (p-value = 0.009721, R2 = 0.08097) and SB time and HADSD (p-value = 0.01932, R2 = 0.0643).Conclusion:We found high levels of sedentary behavior and poor sleep quality in people who have RA, however no statistically significant relationship was found in this study. Future research should further explore the complex associations between sedentary behavior and sleep quality in people who have RA.References:[1]Carmona L, et al. Rheumatoid arthritis. Best Pract Res Clin Rheumatol 2010;24:733–745.[2]Anon. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab = Physiol Appl Nutr Metab 2012;37:540–542.[3]Fenton, S.A.M. et al. Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. BMC Musculoskelet Disord 18, 131 (2017).[4]McKenna S, et al. Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis. Rheumatol Int. 2018 May;38(5):845-853.[5]Grabovac, I., et al. 2018. Sleep quality in patients with rheumatoid arthritis and associations with pain, disability, disease duration, and activity. Journal of clinical medicine, 7(10)336.Table 1.Sleep quality in people who have RASleep variableBed Time N(%) before 10pm13(18%) 10pm-12pm43 (60%) after 12pm16 (22%)Hours Sleep mean(SD)6.56 (1.54)Fall Asleep minutes mean(SD)33.3(27.7)Night Waking N(%)45(63%)Self-Rate Sleep mean(SD)2.74 (0.90)Hours Sleep mean(SD)6.56 (1.54)Disclosure of Interests:None declared

scholarly journals Clinical Significance of Serum Levels of ROM (Reactive Oxygen Metabolites) in Patients With Rheumatoid Arthritis Treated With Biologic Agents as a Predictor for the CDAI-, SDAI-, and Boolean-Remission

2021 ◽  
Author(s):  
Arata Nakajima ◽  
Keiichiro Terayama ◽  
Masato Sonobe ◽  
Yorikazu Akatsu ◽  
Junya Saito ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Assessment ◽  
Multivariate Logistic Regression Analysis ◽  
Reactive Oxygen ◽  
Serum Levels ◽  
Current Treatment ◽  
Biologic Agents ◽  
Reactive Oxygen Metabolites ◽  
Matrix Metalloproteinase 3 ◽  
Oxygen Metabolites

Abstract We previously showed that reactive oxygen metabolites (ROM) serum levels were associated with the DAS28 in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether ROM would be predictive of the CDAI-, SDAI- or Boolean-remission. Fifty-one biologic agents (BA)-naïve RA patients were included in this observational study. Associations between ROM, C-reactive protein (CRP), MMP (matrix metalloproteinase)-3, DAS28-ESR, CDAI, SDAI, and health assessment questionnaire (HAQ) at 12 weeks and the DAS28-, CDAI-, SDAI-, and Boolean-remission at 52 weeks were investigated. The DAS28-, CDAI-, SDAI- and Boolean-remission rates at 52 weeks were 66.7, 52.9, 54.9 and 54.9%, respectively. A multivariate logistic regression analysis revealed that ROM and HAQ at 12 weeks were associated with the CDAI-, SDAI- and Boolean-remission at 52 weeks. Receiver operating characteristic (ROC) analyses demonstrated that the cut-off value for CDAI remission was 389.5 U.Carr, and that for SDAI and Boolean remission was 389.5 U.Carr. ROM at 12 weeks of initial treatment with BAs was a predictor for the CDAI-, SDAI-, and Boolean-remission at 52 weeks. Serum levels of ROM may be a useful biomarker in the current treatment strategy aiming at the early remission of RA.

scholarly journals Effect of disease duration and prior disease-modifying antirheumatic drug use on treatment outcomes in patients with rheumatoid arthritis

2019 ◽  
Vol 78 (12) ◽  
pp. 1609-1615 ◽  
Author(s):  
Daniel Aletaha ◽  
Jen-fue Maa ◽  
Su Chen ◽  
Sung-Hwan Park ◽  
Dave Nicholls ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Activity Index ◽  
Health Assessment ◽  
Disease Activity Index ◽  
Response To Therapy ◽  
Joint Disease ◽  
Adalimumab Therapy ◽  
Disease Modifying

ObjectivesTo determine if disease duration and number of prior disease-modifying antirheumatic drugs (DMARDs) affect response to therapy in patients with established rheumatoid arthritis (RA).MethodsAssociations between disease duration or number of prior DMARDs and response to therapy were assessed using data from two randomised controlled trials in patients with established RA (mean duration, 11 years) receiving adalimumab+methotrexate. Response to therapy was assessed at week 24 using disease activity outcomes, including 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)), Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire Disability Index (HAQ-DI), and proportions of patients with 20%/50%/70% improvement in American College of Rheumatology (ACR) responses.ResultsIn the larger study (N=207), a greater number of prior DMARDs (>2 vs 0–1) was associated with smaller improvements in DAS28(CRP) (–1.8 vs –2.2), SDAI (–22.1 vs –26.9) and HAQ-DI (–0.43 vs –0.64) from baseline to week 24. RA duration of >10 years versus <1 year was associated with higher HAQ-DI scores (1.1 vs 0.7) at week 24, but results on DAS28(CRP) and SDAI were mixed. A greater number of prior DMARDs and longer RA duration were associated with lower ACR response rates at week 24. Data from the second trial (N=67) generally confirmed these findings.ConclusionsNumber of prior DMARDs and disease duration affect responses to therapy in patients with established RA. Furthermore, number of prior DMARDs, regardless of disease duration, has a limiting effect on the potential response to adalimumab therapy.

Sleep Problems in Patients with Rheumatoid Arthritis

2013 ◽  
Vol 41 (1) ◽  
pp. 31-40 ◽  
Author(s):  
René Westhovens ◽  
Kristien Van der Elst ◽  
Ann Matthys ◽  
Michelle Tran ◽  
Isabelle Gilloteau
Keyword(s):  
Rheumatoid Arthritis ◽  
Sleep Quality ◽  
Disease Activity ◽  
Daytime Sleepiness ◽  
Sleep Problems ◽  
Short Form ◽  
Negative Relationship ◽  
Additional Patient ◽  
Equation Modeling ◽  
Patient Reported

Objective.To investigate sleep problems, and the relationship between sleep and disease activity, in Belgian patients with established rheumatoid arthritis (RA).Methods.This cross-sectional, observational, multicenter study assessed sleep quality using the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness using the Epworth Sleepiness Scale (ESS). Additional patient-reported outcomes included visual analog scales (VAS) for fatigue and pain, the Medical Outcomes Study Short Form-36 Health Survey, the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Positive and Negative Affect Schedule. Multivariate regression and structural equation modeling identified factors associated with sleep quality, with the 28-joint Disease Activity Score [DAS28-C-reactive protein (CRP)] as a continuous or categorical variable. Analyses were performed on the total population and on patients stratified by disease activity status: remission/low (DAS28-CRP ≤ 3.2) or moderate to high (DAS28-CRP > 3.2).Results.Among 305 patients, mean (SD) age was 57.00 (12.38) years and mean (SD) disease duration was 11.77 (9.94) years. Mean (SD) AIS, PSQI, and ESS scores were 6.8 (4.79), 7.8 (4.30), and 7.3 (4.67), respectively. Mean (SD) VAS fatigue, VAS pain, and HAQ-DI were 45.22 (26.29), 39.04 (26.21), and 1.08 (0.75), respectively. There were significant positive relationships between DAS28-CRP and AIS/PSQI, but a significant negative relationship between DAS28-CRP and ESS. Several potentially confounding factors were identified.Conclusions.Poor control of RA is associated with a reduction in sleep quality and decreased daytime sleepiness, which is likely explained by pain-related alertness. Future prospective studies are needed to confirm potential relationships between sleep quality, sleepiness, and RA treatment.

scholarly journals AB0139 RHEUMATOID ARTHRITIS AND SLEEP QUALITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1097.1-1097
Author(s):  
S. Rekik ◽  
L. Ben Ammar ◽  
S. Boussaid ◽  
S. Jemmali ◽  
E. Cheour ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sleep Quality ◽  
Sleep Problem ◽  
Sleep Problems ◽  
Symptomatic Treatment ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
The Impact

Background:Consequences of rheumatoid arthritis (RA) are many and varied: physical, psycho-affective and financial.Objectives:The objective of our study is to evaluate the impact of RA on sleep quality.Methods:We conducted a cross-sectional study including 49 RA patients. An evaluation of sleep quality using the MOS-Sleep Scale was performed.Results:The mean age of patients was 54.1 years, with a female predominance (89.8%). The mean duration of RA was 11.43 ± 7.32 years with a mean time to diagnosis of 2.35 years. Rheumatoid factor was positive in 77.6% of cases. A atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. All patients were on symptomatic treatment, 57.1% of whom were on corticosteroid therapy. 83.67% of patients were on cs-DMARDs and 14.2% were on biologics. At inclusion, sleep was optimal in 63.2% of cases and the mean Sleep Problem Index was 26.19 ± 22.77.The index of sleep problems was higher in older subjects and in those with long diagnostic delays. The presence of co-morbidities and atlanto-axial dislocation and/or coxitis was associated with impaired sleep quality. Also, VAS pain and EGP were associated with an increase in the sleep problem index. In the multivariate study, EGP, the presence of co-morbidities and atlanto-axial dislocation and/or coxitis were the independent factors affecting sleep quality.Conclusion:The impact of RA on the patient’s quality of life and especially the quality of sleep is confirmed by several studies in the literature. A global management of the patient is necessary in order to adapt well to his disease.Disclosure of Interests:None declared

scholarly journals AB0899 TREATMENT STATUS OF PATIENTS WITH GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN THE AKITA ORTHOPEDIC GROUP ON RHEUMATOID ARTHRITIS REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1753.1-1753
Author(s):  
T. Kawano ◽  
T. Kashiwagura ◽  
M. Kobayashi ◽  
Y. Sugimura ◽  
H. Sato ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Duration ◽  
Japanese Society ◽  
Significant Risk ◽  
Current Treatment ◽  
Mineral Research ◽  
Treatment Status ◽  
Younger Age ◽  
Male Sex ◽  
New Guidelines

Background:Glucocorticoids (GC) have potent anti-inflammatory and immunosuppressive effects and are used to treat a variety of diseases. However, GC are associated with several adverse effects. Glucocorticoid-induced osteoporosis (GIO), a bone metabolism disorder, accounts for 25% of the side effects associated with GC, and long-term use of these agents leads to fragility fractures in 30 to 50% of patients [1]. GC are frequently used to treat rheumatoid arthritis (RA). No report on the current treatment status for glucocorticoid-induced osteoporosis (GIO) has been published following the publication of the new guidelines for the management and treatment of GIO issued by the Japanese Society for Bone Mineral Research provided in 2014 (Figure 1) [2].Objectives:The present study aimed to investigate the current treatment status of GIO patients in the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry.Methods:This retrospective, multicenter study included 683 patients (138 men, 545 women) with fracture risk factor scores ≥3 based on the new guidelines who were in the AORA registry. We examined patient characteristics, differences in patient backgrounds between treated and non-treated groups.Results:There were no significant differences in mean GC dose between men and women (4.0 ± 2.3 mg/day vs 3.6 ± 1.8 mg/day, p = 0.08). The mean disease duration of RA in women was significantly longer than in men (180.2 ± 140.2 months vs 143.8 ± 129.6 months, Untreated GIO patients were significantly more likely to be men and younger. The univariate analysis showed that clinic visits, male sex, younger age, and longer disease duration were significant risk factors for lack of therapeutic intervention for GIO. Multivariate analysis showed that being treated in a clinic, male sex, and younger age were significant risk factors for lack of therapeutic intervention for GIO.Conclusion:Our results emphasize the importance of considering the prevention and treatment of GIO in all patients with RA, including younger and male patients, who have lower intervention rates.References:[1]Weinstein RS. Clinical practice. Glucocorticoid-induced bone disease. New Engl J Med. 2011; 365(1): 62-70.[2]Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014; 32(4): 337-350.Disclosure of Interests:None declared

scholarly journals Comparative Analyses of Serological Biomarkers and Disease Characteristics between Elderly-onset and Younger-onset Rheumatoid Arthritis

2021 ◽  
Vol 16 (1) ◽  
pp. 237-245
Author(s):  
Rajalingham Sakthiswary ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Functional Disability ◽  
Disease Duration ◽  
Severe Disease ◽  
Age At Onset ◽  
Health Assessment ◽  
Joint Damage ◽  
Study Data ◽  
Elderly Onset

The onset of rheumatoid arthritis (RA) may occur any time after the age of 16 years. The purpose of this study was to compare the clinical and serological differences between elderly onset RA (EORA); which is begins at the age of 60 and above, with younger onset RA (YORA). A total of 69 EORA and 82 YORA female patients were enrolled in this study. Data on medications, disease duration, age at onset, disease activity at onset and laboratory parameters were collected by reviewing the medical records. All patients had their blood samples taken for serum anticyclic citrulinated peptide (anti-CCP), IgA rheumatoid factor (RF), IgM RF and IgG RF. Besides, the subjects were assessed for their radiographic joint damage based on Modified Sharp Score (MSS) and functional disability based on the Health Assessment Questionnaire-disability Index (HAQ-DI) scores. Despite comparable disease duration and frequency of seropositivity, the YORA group had significantly higher disease activity at onset of the disease (p=0.009). In keeping with this finding, the YORA group had more severe joint damage based on radiographic assessment (MSS scores of 17.49+19.04 versus 10.04+12.79). The YORA group had significantly higher levels of IgA RF and anti-CCP with p-values of 0.035 and 0.002, respectively. Our findings suggest that YORA is associated with more severe disease, worse radiographic joint damage and higher levels of anti-CCP and IgA RF.

scholarly journals The negative bone effects of the disease and of chronic corticosteroid treatment in premenopausal women affected by rheumatoid arthritis

Reumatismo ◽  
2016 ◽  
Vol 68 (2) ◽  
pp. 65 ◽  
Author(s):  
A. Fassio ◽  
L. Idolazzi ◽  
M.A. Jaber ◽  
C. Dartizio ◽  
O. Viapiana ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Femoral Neck ◽  
Corticosteroid Therapy ◽  
Functional Impairment ◽  
Health Assessment ◽  
Premenopausal Women ◽  
Corticosteroid Treatment ◽  
Mineral Density ◽  
Negative Effect ◽  
Chronic Corticosteroid

Osteoporosis is a well-known extra-articular complication in rheumatoid arthritis (RA). The chronic corticosteroid treatment, the functional impairment associated with RA and the disease itself appear to be the most relevant determinants. Most of the previous studies involved postmenopausal women, in whom the estrogenic deficiency might amplify the negative effect towards bone of both RA and corticosteroid therapy. We decided to evaluate bone health in a cohort of premenopausal RA patients. The study population includes 47 premenopausal women attending our outpatient clinic for RA and twice as many healthy age-matched control women selected from the hospital personnel. The bone density at the spine and femoral neck were significantly lower in patients with RA as compared with controls. When spine bone mineral density (BMD) values were adjusted for the cumulative glucocorticoid (GC) dose alone and for the cumulative GC dose plus body mass index (BMI) the mean differences between two groups decreased but they remained statistically significant. We found no difference when the spine BMD was adjusted for cumulative GC dose, BMI and health assessment questionnaire. The difference in femoral neck BMD remained statistically significant also after all the same adjustments. In conclusion, our study shows that a BMD deficiency is frequent also in premenopausal women affected by RA, especially at femoral site and that the main determinants of this bone loss are not only the disease-related weight loss, corticosteroid therapy and functional impairment, but also the systemic effects of the disease itself.

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