Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity

Nevin Hammam; Rania M Gamal; Ahmed Mohammed Rashed; Noha Abo Elfetoh; Eman Mosad; Eman M Khedr

doi:10.1016/j.reuma.2018.07.010

Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity

Reumatol Clin (Engl Ed). 2020 Sep-Oct;16(5 Pt 1):339-344. doi: 10.1016/j.reuma.2018.07.010. Epub 2018 Aug 20.

[Article in English, Spanish]

Authors

Nevin Hammam¹, Rania M Gamal², Ahmed Mohammed Rashed², Noha Abo Elfetoh³, Eman Mosad⁴, Eman M Khedr³

Affiliations

¹ Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt; Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada. Electronic address: hammam@ualberta.ca.
² Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
³ Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt.
⁴ Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

PMID: 30139690
DOI: 10.1016/j.reuma.2018.07.010

Abstract

Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue.

Methods: This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints.

Results: RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis.

Conclusion: Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.

Keywords: Actividad de la enfermedad; Artritis reumatoide; Depresión; Depression; Disease activity; Fatiga; Fatigue; Rheumatoid arthritis; Sleep disturbance; Trastorno del sueño.

MeSH terms

Adult
Aged
Arthritis, Rheumatoid / complications*
Arthritis, Rheumatoid / physiopathology
Arthritis, Rheumatoid / psychology
Case-Control Studies
Cross-Sectional Studies
Depression / diagnosis
Depression / etiology*
Depression / physiopathology
Depression / psychology
Fatigue / diagnosis
Fatigue / etiology*
Fatigue / physiopathology
Fatigue / psychology
Female
Humans
Male
Middle Aged
Psychological Tests
Risk Factors
Severity of Illness Index
Sleep Initiation and Maintenance Disorders / diagnosis
Sleep Initiation and Maintenance Disorders / etiology*
Sleep Initiation and Maintenance Disorders / physiopathology
Sleep Initiation and Maintenance Disorders / psychology