Background:Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.Objectives:To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.Methods:This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.Results:This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.Conclusion:Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.Disclosure of Interests:None declared
BackgroundThe consequences of chronic inflammatory rheumatisms (CIR) on the sexuality and the relationships between the subject and his/her partner are still underestimated and insufficiently studied.ObjectivesThe aim of this study was to investigate the impact of CIR on conjugal relationships.MethodsWe conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). All the patients included in the study were married. We collected demographic data, and participants were asked to complete a questionnaire on their conjugal relationships.ResultsWe enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. The mean duration of marriage was 9.5 ± 2.6 years. The mean age at marriage was 27 ± 6.41 years [19-33]. The mean number of off-springs was 4. Forty-nine percent of patients and 22.3% of the partners had a profession, respectively. Forty one percent of the partners had a chronic disease: diabetes (n=12), hypertension (n=10), dyslipidemia (n=7), CIR (n=7), coronary disease (n=3), and other conditions (n=5). A psychiatric illness was noted in 22.6% of cases: depression (n=9), anxiety (n=6), and bipolar disorder (n=2). Sixty-four percent of patients consider their spouses sympathetic to their illness. Eighty-nine percent of participants have noticed a change in their life as a couple before and after the CIR onset. According to 64% of participants, the CIR had a negative impact on their married lives. The spouses’ emotional reactions to the disease were as follows: indifference (30.6%), denial (29.3%), anger (26.6%), and fear (13.6%). Patients reported being accompanied by their spouses to their medical appointments in 36% of cases, and 40% of them were asked questions by their spouses about their disease and treatment. The CIR has resulted in the termination of the marriage in 2.6% of cases.ConclusionPatients suffering from chronic diseases such as CIR are more frequently exposed to difficulties in their conjugal relationships. The disease has thus important consequences on the subject’s quality of life, emotional and interpersonal state. A better compliance with the chronic disease and its treatment may improve the couples’ relationships.Disclosure of InterestsNone declared
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