Aydemir Burcu, Schieir Orit, Valois Marie-France, Muhammad Lutfiyya N, Song Jing, Dunlop Dorothy, Chang Rowland W, Bartlett Susan J, Bessette Louis, Boire Gilles, Hazlewood Glen, Hitchon Carol, Pope Janet, Thorne Carter, Tin Diane, Bykerk Vivian P, Lee Yvonne C
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
McGill University, Montreal, Quebec, Canada.
Arthritis Care Res (Hoboken). 2025 Sep;77(9):1078-1084. doi: 10.1002/acr.25568. Epub 2025 Jun 23.
This study investigated whether sleep disturbance can predict the extent to which pain interferes with daily functioning in patients with early rheumatoid arthritis (RA).
Data were from adults with early RA (joint symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort between 2016 and 2023. Participants underwent standardized clinical assessments and completed Patient-Reported Outcomes Measurement Information System measures at 0, 6, 12, 18, and 24 months to assess sleep disturbance (primary predictor) and pain interference (primary outcome). Linear mixed-effects models were used to estimate crude and adjusted (age, sex, body mass index, education, income, smoking status, comorbidities, disease activity, treatment, and depression) effects of sleep disturbance on pain interference over the 24-month study period. The analysis was lagged so that repeat measures of sleep disturbance at 0, 6, 12, and 18 months were evaluated as predictors of pain interference 6 months later at 6, 12, 18, and 24 months' follow-up.
The analysis included 502 patients with early RA. At baseline, the sample was 68% female and 81% White; the mean age was 56 (SD 14) years, and the mean disease duration was 5.4 (SD 2.9) months. The unadjusted and adjusted linear mixed-effects models revealed a significant association between sleep disturbance and subsequent pain interference scores, indicating that worse sleep six months prior was associated with greater pain interference at the following six-month evaluation.
These findings underscore the importance of addressing sleep disturbances as part of pain management strategies soon after RA diagnosis. Identifying and targeting problematic sleep disturbances early on may help improve long-term pain outcomes.
本研究调查了睡眠障碍是否能够预测疼痛对早期类风湿关节炎（RA）患者日常功能的干扰程度。
数据来自于2016年至2023年间纳入加拿大早期关节炎队列研究的成年早期RA患者（关节症状≤12个月）。参与者接受了标准化临床评估，并在0、6、12、18和24个月时完成患者报告结局测量信息系统测量，以评估睡眠障碍（主要预测因素）和疼痛干扰（主要结局）。采用线性混合效应模型来估计在24个月的研究期间，睡眠障碍对疼痛干扰的粗略和调整后（年龄、性别、体重指数、教育程度、收入、吸烟状况、合并症、疾病活动度、治疗和抑郁）效应。分析采用滞后方式，以便将0、6、12和18个月时睡眠障碍的重复测量值作为6个月后在6、12、18和24个月随访时疼痛干扰的预测因素进行评估。
分析纳入了502例早期RA患者。在基线时，样本中68%为女性，81%为白人；平均年龄为56（标准差14）岁，平均病程为5.4（标准差2.9）个月。未调整和调整后的线性混合效应模型显示，睡眠障碍与随后的疼痛干扰评分之间存在显著关联，表明前6个月睡眠越差，在接下来的6个月评估中疼痛干扰越大。
这些发现强调了在RA诊断后不久将解决睡眠障碍作为疼痛管理策略一部分的重要性。尽早识别并针对有问题的睡眠障碍可能有助于改善长期疼痛结局。
