Debta Debashish K, Padarabinda Tripathy Krishna, Jain Tejash, Behera Pradip K, Chodey Sasidhar, Sai Mrinalini, Agarwal Pooja, Karnati Bharath V, Padhan Prasanta
General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND.
Cureus. 2025 May 25;17(5):e84767. doi: 10.7759/cureus.84767. eCollection 2025 May.
Introduction Rheumatoid arthritis (RA), a chronic inflammatory disorder, is associated with significant joint pain, functional disability, and systemic inflammation. Sleep, a vital physiological process, plays a crucial role in immune regulation and tissue repair. Disruptions in sleep patterns are prevalent among RA patients, yet remain underdiagnosed and undertreated. A two-year study investigates the prevalence of sleep disturbances in RA patients and explores the association between pain perception and disease severity. Materials and methods A cross-sectional observational study was conducted from March 2023 to March 2025 in the Departments of General Medicine and Rheumatology at KIMS PBMH, Bhubaneswar. The study included 176 participants, comprising 88 RA patients diagnosed using the 2010 ACR-EULAR Classification criteria and 88 age and sex-matched controls. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with a score ≥5 indicating poor sleep quality. Insomnia severity was evaluated using the Insomnia Severity Index (ISI). RA disease activity was classified using the Disease Activity Score-28 (DAS-28). Pain perception as per the Visual Analogue Scale (VAS) was graded as no pain, mild, moderate or severe. Results Among RA patients, 66 (74.0%) were classified as poor sleepers compared to 5 (5.7%) of controls (p<0.001). Insomnia was prevalent in 67 (76.1%) of RA patients, with 37 (42.0%) experiencing moderate insomnia and 24 (27.3%) severe insomnia (p<0.001). Severe pain was reported by 26 (29.5%) of RA patients versus none in the control group (p<0.001). Disease activity was significantly associated with sleep disturbances: 22 (25%) had mild RA, 38.6% moderate, and 36.4% severe disease activity. Higher DAS-28 scores correlated with poorer sleep quality and increased insomnia severity (p<0.001). Severe pain was a significant determinant of sleep disruption (p<0.001). The findings underscore a strong link between RA, pain, and sleep disturbances. Conclusion Sleep disturbances are highly prevalent in RA patients and strongly correlate with disease severity and pain perception. Routine sleep assessment should be integrated into RA management. Interventions such as cognitive behavioral therapy for insomnia (CBT-I) and pharmacologic treatments targeting both pain and sleep may improve clinical outcomes. Further longitudinal research is warranted to explore causal pathways and the impact of sleep interventions on RA progression.
引言
类风湿关节炎（RA）是一种慢性炎症性疾病，与严重的关节疼痛、功能障碍和全身炎症相关。睡眠是一个至关重要的生理过程，在免疫调节和组织修复中起着关键作用。睡眠模式紊乱在RA患者中很普遍，但仍未得到充分诊断和治疗。一项为期两年的研究调查了RA患者睡眠障碍的患病率，并探讨了疼痛感知与疾病严重程度之间的关联。
材料与方法
2023年3月至2025年3月，在布巴内斯瓦尔KIMS PBMH的普通内科和风湿病科进行了一项横断面观察性研究。该研究包括176名参与者，其中88名RA患者根据2010年美国风湿病学会（ACR）和欧洲抗风湿病联盟（EULAR）分类标准确诊，88名年龄和性别匹配的对照者。使用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，得分≥5表明睡眠质量差。使用失眠严重程度指数（ISI）评估失眠严重程度。使用疾病活动评分-28（DAS-28）对RA疾病活动进行分类。根据视觉模拟量表（VAS）将疼痛感知分为无疼痛、轻度、中度或重度。
结果
在RA患者中，66名（74.0%）被归类为睡眠质量差，而对照组为5名（5.7%）（p<0.001）。67名（76.1%）RA患者存在失眠，其中37名（42.0%）为中度失眠，24名（27.3%）为重度失眠（p<0.001）。26名（29.5%）RA患者报告有重度疼痛，而对照组无人报告（p<0.001）。疾病活动与睡眠障碍显著相关：22名（25%）患有轻度RA，38.6%为中度，36.4%为重度疾病活动。较高的DAS-28评分与较差的睡眠质量和增加的失眠严重程度相关（p<0.001）。重度疼痛是睡眠中断的一个重要决定因素（p<0.001）。这些发现强调了RA、疼痛和睡眠障碍之间的紧密联系。
结论
睡眠障碍在RA患者中非常普遍，并且与疾病严重程度和疼痛感知密切相关。应将常规睡眠评估纳入RA管理中。诸如失眠的认知行为疗法（CBT-I）以及针对疼痛和睡眠的药物治疗等干预措施可能会改善临床结局。有必要进行进一步的纵向研究，以探索因果途径以及睡眠干预对RA进展的影响。
