3 years ago

Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity

Nevin Hammam, Rania M. Gamal, Ahmed Mohammed Rashed, Noha Abo Elfetoh, Eman Mosad, Eman M. Khedr

Publication date: Available online 20 August 2018

Source: Reumatología Clínica

Author(s): Nevin Hammam, Rania M. Gamal, Ahmed Mohammed Rashed, Noha Abo Elfetoh, Eman Mosad, Eman M. Khedr


Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue.


This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints.


RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2 ± 8.9, 6.4 ± 3.6, and 12.8 ± 7.3; respectively) than controls (22.7 ± 7, 4.8 ± 3, 7.8 ± 5.9; respectively) (P < .05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r = 0.4, r = 0.65, r = 0.55; respectively) (P < .001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis.


Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.


La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, caracterizada por poliartritis y manifestaciones sistémicas. La fatiga asociada a AR es un problema importante y aumenta la carga de la enfermedad. La alteración del sueño, la depresión y la actividad de la enfermedad son factores sugeridos que contribuyen a la fatiga asociada a AR; sin embargo, su papel no se ha examinado previamente en pacientes egipcios con AR. El objetivo del estudio fue investigar la presencia de fatiga y alteraciones del sueño y humor en pacientes con AR. Además, evaluar la posible asociación del sueño deficiente, depresión y la actividad de la enfermedad con la fatiga asociada a AR.


Este estudio transversal incluyó 115 pacientes con AR, diagnosticados según los criterios de la ACR-EULAR 2010 y 46 pacientes de control emparejados por edad y sexo. Se evaluó en todos los participantes la fatiga mediante el índice de evaluación multidimensional de la fatiga y la fatiga global, el sueño utilizando el índice de calidad del sueño de Pittsburgh y el estado de ánimo mediante el Inventario de Depresión de Beck. La actividad de la enfermedad de la AR se evaluó utilizando la medida de la actividad de enfermedad-28 articulaciones.


Los pacientes con AR presentaron en promedio una mayor fatiga, alteración del sueño y puntuaciones de depresión (27,2 ± 8,9; 6,4 ± 3,6 y 12,8 ± 7,3, respectivamente) que los pacientes de control (22,7 ± 7; 4,8 ± 3 y 7,8 ± 5,9, respectivamente) (p < 0,05). El sueño deficiente, la depresión y una mayor actividad de la enfermedad se correlacionaron significativamente con la fatiga (r = 0,4; r = 0,65; r = 0,55, respectivamente) (p < 0,001). Las 3 variables pueden explicar hasta el 49,1% de la variación en fatiga en el análisis de regresión múltiple.


La fatiga, el sueño deficiente y la depresión son más comunes en pacientes egipcios con AR. Una notablemente alta fatiga se asoció con un sueño deficiente, depresión y alta actividad de la enfermedad, por lo que se requiere el control de estas comorbilidades silenciosas en la práctica clínica.

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