36º Congresso Brasileiro de Reumatologia

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Pain and Anxiety are Independent Factors Associated to Sleep Impairment in Psoriatic Arthritis: a Multicentric Study in 14 Countries


Sleep quality is diminished in patients with psoriatic arthritis (PsA) and close to 40% of PsA patients consider sleep impairment a priority domain.This work analyzed determinants of impaired sleep in patients with PsA.

Materials and methods

This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805), which included adult patients with definite PsA with ≥ 2 years disease duration from 14 countries. Sleep was assessed using the patient self-reported evaluation of sleep on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). A score ≥ 4 was considered as sleep impairment. Demographic and clinical variables associated to sleep impairment were assessed through univariate analysis; prevalence ratios (PR)[95% CI] were reported. Variables independently associated to sleep impairment in the univariate analysis (with p-value <0.05) were entered in the Poisson regression model.


A total of 396 patients were analyzed: mean age 51.9 ± 12.6, 51% (N= 202) were females, 59.7% were receiving biologic therapy (N= 221), 53.3% (N=201) of participants had 1-5% of body surface area (BSA) affected by psoriasis, 74% (N=293) had mild disability (defined as a score ≤1 in the Health Assessment Questionnaire-HAQ); 23.7% (N=94) were in remission and 36.9% (N=146) in low disease activity according to the Disease Activity in Psoriatic Arthritis (DAPSA) score. Median (25th-75th) patient’s self-evaluation of sleep difficulties was 2 (0-6), 39.9% (N=158) were considered as having sleep impairment. In the univariate analysis, factors independently associated to sleep impairment were: moderate (HAQ >1 to 2) and severe (HAQ >2 to 3) disability (PR: 1.55 [1.39-1.72] and 2.07 [1.97-2.18] respectively, p<0.001), glucocorticoid use (PR: 1.52 [1.16-1.99], p=0.003), obesity (PR: 1.50 [1.06-2.11], p=0.021), psoriasis affecting >20% of BSA (PR: 1.12 [1.08-1.17], p<0.001), moderate and high disease activity by DAPSA (PR: 7.01 [3.54-13.8] and 8.71 [4.46-17.9] respectively, p<0.001) and self-reported levels of anxiety, depression and fatigue (PR: 1.22 [1.18-1.28], 1.16 [1.14-1.21] and 1.28 [1.23-1.33] respectively, p<0.001). Poisson regression model showed only self-reported levels of anxiety (PR: 1.05 [1.02-1.08], p=0.003) and the pain component of DAPSA (PR: 1.06 [1.01-1.09], p<0.001) contributing to sleep impairment .


Sleep impairment was frequent in this population of PsA patients; pain and anxiety were independently associated to sleep impairment.


Psoriatic Arthritis


Penélope Esther Palominos, Laura C Coates, Charles Lubianca Kohem, Ana-Maria Orbai, Josef S Smolen, Maarten de Wit, Uta Kiltz, Ying Ying Leung, Juan D Cañete, Rossana Scrivo, Andra Balanescu, Emmanuelle Dernis, Sandra Tälli, Martin Soubrier, Sibel Zehra Aydin, Inna Gaydukova, Umut Kalyoncu, Laure Gossec