Can rheumatoid arthritis affect sleep in Egyptian patients?

A comparative study between rheumatoid arthritis and osteoarthritis regarding association of insomnia with disease status

Background

Sleep disturbance is closely related to inflammation and pain. Good sleep quality is essential for patients’ psychological and physical states as well as their quality of life. The aim of this study was to detect how insomnia as a major sleep disturbance could add to the disease burden in rheumatoid arthritis (RA) and osteoarthritis patients (OA) and to determine the predictor parameters in each of them in order to orient the rheumatologist to this unnoticed symptom that could adversely affect the patients’ life. This study included: 20 RA patients, 20 primary knee OA patients together with 20 healthy controls. RA disease activity was assessed by the disease activity score (DAS-28). All participants were assessed for sleep disturbances by the Athens Insomnia Scale, quality of life (QoL) using the short form QoL (SF-36 QoL) scale, depression by the Beck depression inventory (BDI), and functional disability by the Health Assessment Questionnaire Disability Index (HAQ-DI). OA patients were assessed by the Knee OA Flare Up Score (KOFUS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Radiological evaluation for RA patients was done by the Simple Erosion Narrowing Score, while the Kellgren and Lawrence (K-L) radiological grading system was used for OA patients.

Results

Insomnia was found in 75% of the studied RA patients, 25% of the studied OA patients and none of the healthy control with significant difference (P < 0.001). Significant correlations of the insomnia scale with the number of tender and swollen joints (r = 0.66, 0.76 respectively and p = 0.001 both), DAS-28 (r = 0.71, P < 0.001), anti-CCP antibodies titre (r = 0.53, p = 0.02) and the BDI (r = 0.65, p = 0.002) among RA patients were found. Correlations among OA patients occurred with morning stiffness duration (r = 0.69, P = 0.001), number of affected joints (r = 0.81, P = 0.001), the BDI scale (r = 0.51, P = 0.02), the WOMAC index (r = 0.57, P = 0.009), the KOFUS score (r = 0.76, p < 0.001) and the K-L score (r = 0.67, P = 0.001). Linear regression analysis indicated that the predictors for insomnia in RA were DAS-28 and the BDI, while in OA were the number of affected joints and the KOFUS score.

Conclusions

Insomnia is a disease burden especially in RA patients being one of the leading causes of depression and is greatly affected by the disease activity. In general the burden of insomnia is much less in OA except in severe cases with markedly affected joints. Rheumatologists should be aware of this disorder that could affect patients’ health, mood, and functional activity.

The effect of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis: A randomized controlled trial

AIMS

The aim of this study was to investigate the effects of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis.

METHODS

This randomized controlled study was conducted with 72 patients with rheumatoid arthritis who applied to the rheumatology outpatient clinic of a university hospital between January and May 2018. The data were collected using the Patient Information Form, Pittsburgh Sleep Quality Index and Fatigue Severity Scale. After the patients in the intervention group completed the forms, patients were given training with regard to the application of progressive muscle relaxation which they subsequently performed, and the Pittsburgh Sleep Quality Index and Fatigue Severity Scale forms were repeated after 6 weeks.

RESULTS

After performing progressive muscle relaxation for 6 weeks, the total score of the Pittsburgh Sleep Quality Index and the fatigue score decreased among patients in the intervention group; no change was observed among the patients in the control group. A statistical difference was found between the two groups in terms of the Pittsburgh Sleep Quality Index's and Fatigue Severity Scale's mean scores.

CONCLUSION

Progressive muscle relaxation can be recommended to enhanced sleep quality and reduce fatigue in patients with rheumatoid arthritis.

Rheumatology in Egypt: back to the future

Medical knowledge in ancient Egypt had a remarkable reputation since rulers of other empires used to request the pharaoh to send them their best physician to treat their beloved ones. Many rheumatologic conditions as giant-cell arteritis, reactive arthritis and other forms of spondyloarthritis have been identified in ancient Egyptian materials. Rheumatologists in Egypt are enormously expanding and mastering the tools that aid them in enhancing the management of rheumatic diseases. More Egyptian rheumatologists are actively participating in the annual European League Against Rheumatism (EULAR) and American College of Rheumatology conferences and those attached to well known state of the art centers are increasing. EULAR certified Egyptian MSUS trainers are effectively performing regionally. This review throws light on the rheumatology practice in Egypt, its progress from ancient times passing through Egyptian medical healthcare services, education systems for rheumatologists, rheumatology associations, an overview on the spectrum of rheumatic diseases through publications in the field till future perspectives. Rheumatology in Egypt is an actively growing and dynamic specialty of medicine with considerable contributions to the world's literature. These days, persistent efforts are mandatory to raise the standard of clinical and basic research, to optimize clinical practice with regard to new biologics, to develop tailored and targeted therapies for the rheumatic diseases, and to meet the medical demands of the exponentially increasing Egyptian population. Opportunities and challenges discussed high-lighten future perspectives needed to boost the rheumatology practice in Egypt.