The effects of differing pharmaceutical preparations of indomethacin on night pain and morning stiffness in patients with rheumatoid arthritis

Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life

BACKGROUND

The aim of this study was to evaluate sleep quality and the related variables in patients with rheumatoid arthritis (RA).

METHODS

Ninety-four patients diagnosed with RA and fifty two healthy controls were enrolled in the study. Disease activity was assessed through the Disease Activity Score (DAS) 28 scale. All patients were assessed using the Rheumatoid Arthritis Quality of Life and Health Assessment Questionnaire scales, together with the Beck Depression Inventory. Radiological damage was calculated with the modified Larsen method. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of the sleep disturbance.

RESULTS

The patients with RA had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance domains and the total PSQI score compared to the healthy control group. According to the results of Spearman's analysis, there was a significantly correlation between the age, disease activity, CRP, pain, fatigue, depression, functional disability, quality of life, radiological damage, menopause status, duration of morning stiffness, ESR levels and the sleep disturbance. The logistic regression analysis indicated that depression and DAS 28 scores were predictors for poor sleep quality.

CONCLUSION

The sleep quality is disturbed in patients with RA. The poor sleep quality is especially associated with the disease activity and depression.

Investigating sleep disturbances in adults with rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation and joint involvement. Most adults with RA experience sleep disturbances, including longer times before falling asleep, numerous awakenings during the night, and early morning wakening, resulting in excessive daytime sleepiness and fatigue. This article will review what is known about sleep disturbances and the biologic basis in adults with RA, the influence of ovarian hormone levels in women with RA, how medications may influence sleep in RA, and complementary and alternative therapies that may be useful in reducing sleep disturbances.

Nighttime sleep and daytime functioning (sleepiness and fatigue) in well-defined chronic rheumatic diseases

Wake/sleep complaints are very common in the rheumatic diseases, and include: insomnia, non-restorative sleep, frequent awakenings, daytime fatigue and excessive daytime sleepiness. Imprecise use of terminology has confused 'sleep dissatisfaction' (i.e. 'non-restorative sleep') with specific sleep disorders (i.e. 'insomnia' or 'sleep fragmentation') and 'fatigue' with 'daytime sleepiness'. This review examines current concepts from the literature of disparate disciplines pertaining to the complaint of poor sleep and daytime fatigue in patients with rheumatic disorders. The ability to monitor multiple physiologic parameters during sleep (polysomnography) has led to a greater understanding of normal and abnormal phenomena which occur during sleep, and has resulted in the identification of a variety of sleep disorders which have specific therapeutic implications. Actigraphy allows the prolonged monitoring of wake/sleep patterns, and the multiple sleep latency test permits the determination of physiologic sleepiness during the daytime. These techniques enable identification of objective sleep disorders in those whose complaint is subjective sleep dissatisfaction, and permit differentiation between the easily confused complaints of excessive daytime sleepiness and fatigue. The abnormal sleep/wake symptoms in patients with rheumatic diseases may not simply be a 'non-specific' or systemic effect of the disease. Some patients may have a specific sleep disorder (either independent from, or due to, the underlying rheumatic condition) which should be diagnosed and treated specifically. Conversely, subjective 'sleep dissatisfaction' does not necessarily imply an underlying sleep disorder. The primary intent of this review is to encourage systematic, objective study of sleep and daytime function in these common, often disabling conditions.

Visual analog scale for the assessment of total hip arthroplasty

The use of a visual analog scale (VAS) for the assessment of total hip prostheses was evaluated in 54 patients (58 hips), on average 3.4 years following operation. The Harris hip scores were determined in each case and the patients were also asked to record their overall assessment of their new hips on a VAS. Five patients (6 hips) were unable to understand and use the VAS. For the remaining 49 patients (52 hips), the Harris hip score averaged 84 (41-100) and the VAS score 75 (2-100). There was a high correlation between the Harris hip scores and the VAS scores (+0.84). Use of a VAS provides a simple and reliable basis for the assessment of a total hip arthroplasty.

The basis for variability of response to anti-rheumatic drugs

The reasons for variability of response to anti-rheumatic drugs are myriad. All the factors that contribute to kinetic variability, for example, contribute to differences in response between individuals. Thus, differences in drug formulation, protein binding, drug metabolism and excretion, all contribute to variable responses. Further, factors which contribute to differential clinical response/toxicity must be considered. Here, age, gender, genetic background, weight, concomitant diseases and numerous environmental factors come into play. Among the environmental factors are such diverse elements as smoking, activity and diet. Finally our ability to measure change, be it in response or toxicity, is limited, introducing apparent variability (as much as real variability) into the equation. While we cannot, at present, delineate the contribution of each factor to individual variability, it is hoped that systematic, persistent effort will help us understand and then control these elements, leading to improved ability to individualize therapy and decrease the variability of response to anti-rheumatic drugs.