AB0554 SLEEP QUALITY IN PATIENTS WITH PSORIATIC ARTHRITIS
Authors: P. Benzin, Z. R. Stisen, M. Skougaard, T. Schjødt Jørgensen, R. L. Hansen, L. M. Perez-Chada, M. Mogensen, J. F. Merola, L. E. Kristensen
Journal: Annals of the Rheumatic Diseases (2021)

Background: Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease. It has a heterogeneous clinical presentation with main features being joint swelling and pain, skin and nail psoriasis, enthesitis, and dactylitis. Self-reported outcomes such as quality of sleep and fatigue are often neglected topics although having great impact on patients’ everyday lives. Objectives: The primary objective was to analyze the prevalence of PsA patients suffering from poor quality of sleep, defined by Pittsburgh Sleep Quality Index (PSQI) score ≥ 5, and to study the association between being a good or poor sleeper and clinical- and patient-reported outcomes. Secondary, the effects on outcomes after initiation of treatment. Methods: Patient characteristics, disease activity and self-reported outcomes were obtained from the PIPA cohort. To evaluate the primary objective, a cross-sectional analysis was conducted including PSQI score at baseline and corresponding data. Patients were divided into two groups, defined as good or poor sleepers (Table 1). Data from initiation of treatment (baseline) and 4 months follow-up were included when assessing the effect of treatment. Transition of good and poor sleepers from baseline to 4 months follow-up was depicted by a chi-squared test. A crosstab analysis was performed with baseline PSQI and whether they had widespread pain to investigate a possible link, additionally a Mann-Whitney U test. Results: From January 2018-November 2020 a total of 109 patients were included. The prevalence of PsA patients suffering from poor quality of sleep at baseline were 66.1% whereas the remaining 33.9% were deemed good sleepers. There was no statistically significant difference in patient demographics when comparing good and poor sleepers at baseline. There was a statistically significant difference in patient-reported outcomes such as Visual Analogue Scale (VAS) pain, VAS global, Health Assessment Questionnaire (HAQ) score and Disease Activity Score (DAS28-CRP), with poor sleepers scoring higher. 57 patients had complete data at 4 months follow-up. At baseline 71.9% of them were classified as poor sleepers (Figure 1). A chi-squared test presented the transition at 4 months follow-up. 47.4% of the patients were now classified as poor sleepers. While 27 poor sleepers became good sleepers, 13 good sleepers became poor sleepers, with data being statistically significant (p 0.001). The crosstab analysis exposed 75 patients without widespread pain (mean 7.13±3.79) and 31 patients with widespread pain (mean 9.52±4.93). Baseline PSQI and whether the patients had widespread pain was statistically significant (p 0.018). Conclusion: Overall, PsA patients with poor quality of sleep have higher levels in terms of self-reported pain and disease activity. The amount of good sleepers after 4 months increased, but there was a negative transition of patients going from good to poor sleepers. This could indicate that more factors are important for quality of sleep, e.g. sociopsychological aspects like anxiety, depression, ability to work. Table 1. Patient characteristics Total n = 109 Good sleepers PSQI ≤ 5 n = 37 Poor sleepers PSQI &gt; 5 n = 72 n n p Female, n (%) 65 (59.4%) 19 (51.4%) 37 46 (63.9%) 72 0.206 Age, yrs 53.9 (45.4-62.25) 60.4 (45.5-65.2) 37 51.5 (44.7-59.95) 72 0.144 Disease duration, yrs 3.86 (1.0-11.0) 4.5 (1.04-11.06) 34 2.91 (1.0-10.75) 68 0.352 csDMARD, n (%) 71 (65.1%) 26 (70.2%) 37 45 (62.5%) 72 0.420 bDMARD, n (%) 70 (64.2%) 24 (64.8%) 37 46 (63.9%) 72 0.920 Patient pain assessment 0-100 mm VAS 50.0 (21.0-74.5) 27.0 (9.0-60.5) 37 63.5 (32.25-78.0) 72 &lt;0.001 Patient global assessment 0-100 mm VAS 61.0 (27.5-78.5) 35.0 (17.5-59.0) 37 69.5 (50.0-85.75) 72 &lt;0.001 PsAID fatigue 6.0 (3.0-8.0) 4.0 (2.5-7.0) 37 6.5 (4.0-8.0) 72 0.488 HAQ score, 0-3 0.75 (0.38-1.25) 0.38 (0.25-0.81) 37 0.88 (0.63-1.38) 72 &lt;0.001 PASI 1.7 (0.0-9.75) 2.0 (0.0-7.3) 35 1.2 (0.0-11.5) 65 0.940 DAS28-CRP 3.77 (3.02-4.58) 3.44 (2.65-3.94) 37 4.07 (3.28-4.93) 72 0.001 Disclosure of Interests: Peter Benzin: None declared., Zara Rebecca Stisen: None declared., Marie Skougaard: None declared., Tanja Schjødt Jørgensen Speakers bureau: Received consulting fees and/or speaking fees from AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: Received consulting fees and/or speaking fees from AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Rebekka L. Hansen: None declared., Lourdes M. Perez-Chada: None declared., Mette Mogensen: None declared., Joseph F. Merola Consultant of: Consultant and/or investigator for Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and Leo Pharma., Lars Erik Kristensen Speakers bureau: Received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Consultant of: Received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals.