Poor Sleep May Worsen RA Symptoms
Link Found Between Poor Sleep Quality and Greater Risk of Pain for Rheumatoid Arthritis Patients
By Bill Hendrick
WebMD Health News
Reviewed by Laura J. Martin, MD
senior man awake in bed

Feb. 16, 2011 -- People with rheumatoid arthritis (RA) who don’t sleep well face significant risks of greater functional disability due to pain and fatigue symptoms associated with poor sleep quality, a new study shows.

Researchers at the University of Pittsburgh studied the relationship between sleep quality and functional disability in 162 patients with rheumatoid arthritis. All patients had been diagnosed with RA for at least two years; their average age was 58.5 and 76% were female.

In addition, each participant had rheumatoid arthritis on average for 14 years. Data were drawn from patient questionnaires on sleep quality, depression, and overall health. Patients provided information concerning fatigue, depression, severity of pain, and functional disability.

Slideshow: Understanding Rheumatoid Arthritis
RA Questionnaire

Results derived from the questionnaire showed that 61% of participants were poor sleepers; 33% reported pain that disturbed their sleep at least three times per week.

“The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with [rheumatoid arthritis] and this relationship may be explained by pain severity and fatigue,” says study researcher Faith S. Luyster, PhD, in a news release. Luyster is a research assistant at the University of Pittsburgh School of Medicine.

“These results highlight the importance of addressing sleep complaints among patients with [rheumatoid arthritis],” she says. “By treating sleep problems, either pharmacologically or behaviorally, symptoms and activity limitations associated with [rheumatoid arthritis] may be reduced.”

The researchers say their findings are consistent with other evidence that suggests that disruption of sleep may lower the threshold for pain, and also worsen it, in otherwise healthy adults.

The study is published in the Feb. 15 issue of the Journal of Clinical Sleep Medicine.

Rheumatoid arthritis is an inflammatory disease that affects about 1.3 million adults in the U.S., causing pain, swelling, stiffness, and loss of function in joints. People with RA have long reported problems with sleep.

Disability from joint disease in people with rheumatoid arthritis may limit their ability to walk, groom themselves, and write, and can be further affected by fatigue, pain, and depression.
Pain, Fatigue, and Depression

The researchers say it’s possible that disability may affect depression, pain severity, and fatigue, which affect sleep quality, but also possible that sleep quality may worsen pain and fatigue and increase risks of depression.

“Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day, which in turn can limit patient’s ability to engage in activities of daily living and discretionary activities,” Luyster says in the news release.

“Addressing sleep problems via pharmacological or behavioral interventions may have a critical impact on the health and lives of patients” with rheumatoid arthritis, the researchers write.

The researchers also say more study is needed to determine whether improving sleep quality can reduce pain, depressive symptoms, fatigue, and disability in people with rheumatoid arthritis.