Abstract
IntroductionSleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. The objective was to explore the occurrence of sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) patients, and their correlates.MethodsA broad data collection was performed in 137 Norwegian PsA outpatient clinic patients including demographics, disease activity measures for both skin and musculoskeletal involvement, and patient-reported outcome measures. Sleep disturbances and fatigue were defined present if the numeric rating scale (0–10) score was ≥ 5. Anxiety/depression was assessed using a questionnaire (1–3; 1 defined as no anxiety/depression). Descriptive statistics was applied, and associations were explored using univariate and adjusted linear regression analysis.ResultsThe mean age was 52.3 years, PsA disease duration 8.8 years; 49.6% were men and 54.8% were currently employed/working. The prevalence of sleep disturbances was 38.0%, fatigue 44.5%, and anxiety/depression 38.0%. In adjusted analysis, pain, fatigue, and higher mHAQ were associated with sleep disturbances. Sleep disturbances, pain, and anxiety/depression were associated with fatigue, whereas only fatigue was associated with anxiety/depression.ConclusionsThe prevalence of sleep disturbances, fatigue, and anxiety/depression was frequently reported by PsA patients. No measures reflecting skin involvement or objective measures of musculoskeletal involvement were independently associated with sleep disturbances, fatigue, or anxiety/depression. Our data suggest that patients’ perceptions of musculoskeletal involvement (pain or mHAQ) play an important role causing sleep disturbances and fatigue, whereas fatigue in PsA patients is strongly associated with anxiety/depression.
Highlights
Sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations
In men compared with women, worse scores were found for Creactive protein (CRP) and Psoriasis Area Severity Index (PASI) score, and worse scores were seen in women for TJC68, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) score, pain, fatigue, sleep disturbances, MHAQ, and comorbidities
As stated in the study by Husted et al, we identified in the univariate analysis a large number of both demographic and disease measures to be significantly associated with fatigue in PsA as shown in Table 2; in the context of sleep disturbances, pain, and anxiety/depression in our PsA patient, they did not achieve statistical significance [39]
Summary
Fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. PsA patients rate sleep disturbances, fatigue, depression, and anxiety to be of greater importance than do doctors [9, 10]. Despite their importance, there is a paucity of relevant data and a need to better understand the interaction and relationship between various physical and psychosocial features and their impact on sleep, fatigue, anxiety, and depression in PsA patients
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