2254: Association of Disease Activity with Insomnia, Depression, and Fatigue in Patients with Rheumatoid Arthritis: A Multicenter Prospective Observational Study

Background/Purpose: Patients with rheumatoid arthritis (RA) often experience not only joint-related symptoms but also systemic issues such as insomnia, depression, and fatigue [1–3]. These symptoms may persist despite therapeutic advances and significantly impair quality of life [1]. This study aimed to clarify the prevalence of insomnia, depression, and fatigue in RA and examine their relationship with disease activity.

Methods: This prospective study enrolled RA patients who could respond to a structured questionnaire. Insomnia was assessed using the Athens Insomnia Scale (AIS), depressive symptoms were evaluated via the Patient Health Questionnaire-9 (PHQ-9), and fatigue was measured using both the Brief Fatigue Inventory (BFI) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Disease activity of RA was measured by the Disease Activity Score in 28 joints with CRP (DAS28-CRP), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI). Functional status of RA was determined through the Health Assessment Questionnaire-Disability Index (HAQ-DI). All patients met the 2010 American College of Rheumatology/ European League Against Rheumatism classification criteria [4] for RA.

Results: A total of 107 RA patients (90 female, 17 male) participated, with a mean age of 55 years and a mean disease duration of 82 months. The median DAS28-CRP was 2.9, CDAI was 10.2, SDAI was 10.2, and HAQ-DI was 0.5. Insomnia was reported in 85% of participants, and the AIS score was significantly associated with DAS28-CRP (r=0.22, p=0.03), CDAI (r=0.23, p=0.03), SDAI (r=0.22, p=0.03), and HAQ-DI (r=0.22, p=0.03). Depression was reported in 13% of participants, and the PHQ-9 score was significant associations with DAS28-CRP (r=0.34, p< 0.01), CDAI, (r=0.34, p< 0.01) and SDAI (r=0.34, p< 0.01). Severe fatigue was also reported in 85% of participants, with BFI scores significantly correlated with DAS28-CRP (r=0.43, p< 0.01), CDAI (r=0.35, p< 0.01), SDAI (r=0.37, p< 0.01), and HAQ-DI (r=0.31, p< 0.01). FACIT-F scores showed inverse correlations with DAS28-CRP (r=0.47, p< 0.01), CDAI (r=0.42, p< 0.01), SDAI (r=0.43, p< 0.01), and HAQ-DI (r=0.25, p=0.01). In addition, the components of disease activity assessment, especially the patient global visual analogue scale, were correlated with AIS (r=0.32, p< 0.01), PHQ-9 (r=0.40, p< 0.01), FACIT-F (r=0.45, p< 0.01), and BFI (r=0.42, p< 0.01).

Conclusion: Insomnia and fatigue were highly prevalent among RA patients, affecting over 80% of patients, while depression was identified in 13%. All symptoms showed associations with disease activity and functional impairment. These findings suggest that optimal RA management should also address psychological and fatigue-related symptoms.



References:

[1] Latocha KM et al. Rheumatology (Oxford). 2023;62:1097-1107.

[2] Kwiatkowska B et al. Psychol Health Med. 2019;24:333-343.

[3] Pope JE. RMD Open. 2020;6:e001084.

[4] Aletaha D et al. Arthritis Rheum. 2010;62:2569-81.



Acknowledgement: M HK and KI are contributed equally.