Anti-Citrullinated Cyclic Peptide Antibody and Functional Disability Are Associated With Poor Sleep Quality in Rheumatoid Arthritis

Overview

Journal Arch Rheumatol

Specialty Rheumatology

Date 2018 Oct 31

PMID 30375543

Authors

Shamala Rajalingam

Rajalingham Sakthiswary

Heselynn Hussein

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aims to determine the predictors of poor sleep quality in rheumatoid arthritis (RA).

Patients And Methods: This was a monocentric, cross sectional, case-control study which was conducted at the Putrajaya Hospital, Malaysia. We recruited 46 patients with RA (3 males; 43 females; mean age 48.15±14.96) and 46 age and sex-matched healthy controls (3 males; 43 females; mean age 47.11±12.22). RA patients were assessed for their disease activity based on disease activity score in 28 joints, disease damage based on radiographic erosions, and functional status based on Health Assessment Questionnaire Disability Index. The Pittsburgh Sleep Quality Index (PSQI) scores were determined by interviewing all the subjects. Subjects with RA were further subdivided based on their PSQI scores as "good sleepers" with PSQI scores of <5 and "poor sleepers" with PSQI scores of ≥5.

Results: The percentage of poor sleepers was significantly higher among RA patients (47.83% versus 9.57%). Median scores of 5 out of 7 components of the PSQI were higher among RA patients compared to controls. Among poor sleepers with RA, a significantly higher proportion tested positive for anti-citrullinated cyclic peptide autoantibodies (p=0.037). Besides, poor sleepers had significantly higher median Health Assessment Questionnaire Disability Index (p=0.017) than good sleepers. However, both Health Assessment Questionnaire Disability Index (p=0.968) and anti-citrullinated cyclic peptide (p=0.431) were insignificant when entered in the equation of a logistic regression model.

Conclusion: The findings of this study demonstrate a link between functional disability, anti-citrullinated cyclic peptide antibodies, and sleep quality in RA.

References

Aletaha D, Neogi T, Silman A, Funovits J, Felson D, Bingham 3rd C . 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010; 69(9):1580-8. DOI: 10.1136/ard.2010.138461. View

Roth T, Price J, Amato D, Rubens R, Roach J, Schnitzer T . The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: a pilot study. Prim Care Companion J Clin Psychiatry. 2010; 11(6):292-301. PMC: 2805564. DOI: 10.4088/PCC.08m00749bro. View

Fransen J, Van Riel P . The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol. 2005; 23(5 Suppl 39):S93-9. View

Son C, Choi G, Lee S, Lee J, Lee T, Jeong H . Sleep quality in rheumatoid arthritis, and its association with disease activity in a Korean population. Korean J Intern Med. 2015; 30(3):384-90. PMC: 4438293. DOI: 10.3904/kjim.2015.30.3.384. View

Wells G, Li T, Tugwell P . Investigation into the impact of abatacept on sleep quality in patients with rheumatoid arthritis, and the validity of the MOS-Sleep questionnaire Sleep Disturbance Scale. Ann Rheum Dis. 2010; 69(10):1768-73. DOI: 10.1136/ard.2009.119727. View

Taylor-Gjevre R, Gjevre J, Nair B, Skomro R, Lim H . Improved Sleep Efficiency after Anti-Tumor Necrosis Factor α Therapy in Rheumatoid Arthritis Patients. Ther Adv Musculoskelet Dis. 2012; 3(5):227-33. PMC: 3383532. DOI: 10.1177/1759720X11416862. View

Prevoo M, van t Hof M, Kuper H, van Leeuwen M, van de Putte L, van Riel P . Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995; 38(1):44-8. DOI: 10.1002/art.1780380107. View

Schurman J, Friesen C, Dai H, Danda C, Hyman P, Cocjin J . Sleep problems and functional disability in children with functional gastrointestinal disorders: an examination of the potential mediating effects of physical and emotional symptoms. BMC Gastroenterol. 2012; 12:142. PMC: 3527282. DOI: 10.1186/1471-230X-12-142. View

Houssien D, McKenna S, Scott D . The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. Br J Rheumatol. 1997; 36(1):69-73. DOI: 10.1093/rheumatology/36.1.69. View

10.

Loppenthin K, Esbensen B, Jennum P, Ostergaard M, Christensen J, Thomsen T . Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis - design of a randomized controlled trial. BMC Musculoskelet Disord. 2014; 15:49. PMC: 3996065. DOI: 10.1186/1471-2474-15-49. View

11.

Bai M, Tomenson B, Creed F, Mantis D, Tsifetaki N, Voulgari P . The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Scand J Rheumatol. 2009; 38(6):419-30. DOI: 10.3109/03009740903015135. View

12.

Maska L, Anderson J, Michaud K . Measures of functional status and quality of life in rheumatoid arthritis: Health Assessment Questionnaire Disability Index (HAQ), Modified Health Assessment Questionnaire (MHAQ), Multidimensional Health Assessment Questionnaire (MDHAQ), Health.... Arthritis Care Res (Hoboken). 2012; 63 Suppl 11:S4-13. DOI: 10.1002/acr.20620. View

13.

Escalante A, del Rincon I . The disablement process in rheumatoid arthritis. Arthritis Rheum. 2002; 47(3):333-42. DOI: 10.1002/art.10418. View

14.

Scheff J, Calvano S, Lowry S, Androulakis I . Modeling the influence of circadian rhythms on the acute inflammatory response. J Theor Biol. 2010; 264(3):1068-76. DOI: 10.1016/j.jtbi.2010.03.026. View

15.

de Vries-Bouwstra J, Goekoop-Ruiterman Y, Verpoort K, Schreuder G, Ewals J, Terwiel J . Progression of joint damage in early rheumatoid arthritis: association with HLA-DRB1, rheumatoid factor, and anti-citrullinated protein antibodies in relation to different treatment strategies. Arthritis Rheum. 2008; 58(5):1293-8. DOI: 10.1002/art.23439. View

16.

Bollinger T, Bollinger A, Skrum L, Dimitrov S, Lange T, Solbach W . Sleep-dependent activity of T cells and regulatory T cells. Clin Exp Immunol. 2008; 155(2):231-8. PMC: 2675254. DOI: 10.1111/j.1365-2249.2008.03822.x. View

17.

Luyster F, Chasens E, Wasko M, Dunbar-Jacob J . Sleep quality and functional disability in patients with rheumatoid arthritis. J Clin Sleep Med. 2011; 7(1):49-55. PMC: 3041613. View

18.

Ibn Yacoub Y, Amine B, Laatiris A, Hajjaj-Hassouni N . Rheumatoid factor and antibodies against citrullinated peptides in Moroccan patients with rheumatoid arthritis: association with disease parameters and quality of life. Clin Rheumatol. 2011; 31(2):329-34. DOI: 10.1007/s10067-011-1820-4. View

19.

Bruce B, Fries J . The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003; 1:20. PMC: 165587. DOI: 10.1186/1477-7525-1-20. View

20.

Makinen H, Kautiainen H, Hannonen P, Sokka T . Is DAS28 an appropriate tool to assess remission in rheumatoid arthritis?. Ann Rheum Dis. 2005; 64(10):1410-3. PMC: 1755218. DOI: 10.1136/ard.2005.037333. View