AB1381 SLEEP QUALITY AND PAIN CHARACTERISTICS IN PATIENTS WITH RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS, AND OSTEOARTHRITIS

Abstract

BackgroundPain is a cardinal symptom of chronic rheumatic conditions and can involve nociceptive and non-nociceptive (neuropathic) components that may be linked to central sensitization. Poor sleep quality has been connected to central sensitization and the appearance of neuropathic pain in patients with chronic rheumatic conditions.ObjectivesWe aimed to investigate pain characteristics and sleep quality in adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA).MethodsWe conducted a prospective observational study including patients with RA, AS and OA who were evaluated in the Rheumatology Department of the Clinical Rehabilitation Hospital of Iasi between July-December 2022. We excluded patients with diabetes mellitus, neoplasia, and comorbid neurological conditions. We evaluated pain intensity using the visual analog scale (VAS) and pain characteristics using the PainDETECT questionnaire (PD-Q). Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI).ResultsThe final study group included 152 patients (50 RA, 52 AS, and 50 OA) with a mean age of 59 years. PD-Q scores did not differ significantly in the three subgroups. In patients with RA, PD-Q scores correlated with disease activity (DAS28 and CDAI; p=0.008 and p=0.036), whereas the relationship between BASDAI and PD-Q scores approached statistical significance (p=0.056). PD-Q scores were correlated with pain intensity in AS (p=0.037), but not RA or OA (p=0.421, p=0.393). In RA patients, nociceptive pain was significantly more prevalent compared to AS and OA (p<0.001) and was associated with a higher consumption of symptomatic medication during hospitalization. Neuropathic pain was notably more frequent in AS compared to RA (p<0.001) and OA (p<0.001). Neuropathic pain did not lead to significantly higher medication expenses in our study group. In the RA subgroup, PD-Q scores were significantly correlated to total PSQI (p<0.001), as well as the values for each of the PSQI domains. Moreover, in these patients, pain intensity was connected to poor subjective sleep quality, low sleep efficiency, and sleep disturbance. Total PSQI scores were also correlated with DAS28 (p=0.011). In AS patients, total PSQI was linked to PD-Q scores (p<0.001), but not pain intensity. PD-Q was significantly connected to subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and sleep disturbance in AS. In the OA subgroup, pain intensity was associated with total PSQI (p=0.007), subjective sleep quality, sleep latency, sleep duration, and sleep efficiency. Nevertheless, poor sleep quality was not significantly linked to neuropathic pain in the OA group.ConclusionNon-nociceptive pain is frequent in patients with chronic rheumatic conditions. Moreover, non-nociceptive pain may impact activity score values in AS and RA. Poor sleep quality is connected to pain intensity and non-nociceptive pain in patients with RA and AS. Sleep quality was not linked to neuropathic pain in OA patients. Pain remains a key symptom in rheumatic diseases and its management remains a challenge for the clinician, especially in the context of central sensitization.