Patients with psoriatic arthritis (PsA) endure a host of physical symptoms, but could those symptoms be contributing to psychological issues? Dr. Matt Birnholz shares a study that examines the prevalence of sleep disturbances, fatigue, anxiety, and depression in PsA patients.
PsA Beneath the Surface: Understanding the Psychological Effects
You’re listening to ReachMD, and this is Beyond Skin Deep: Impacts of Psoriatic Arthritis, sponsored by Lilly. Your host is Dr. Matt Birnholz.
Welcome to Beyond Skin Deep: Impacts of Psoriatic Arthritis. I’m Dr. Matt Birnholz, and on this program, I’ll be reviewing an article published by a Norwegian research team in the Arthritis Research & Therapy journal titled, “Psoriatic Arthritis: Exploring the Occurrence of Sleep Disturbances, Fatigue, and Depression and Their Correlates.”
Psoriatic arthritis reveals itself in many ways through a range of physical symptoms, from pain and stiffness in the joints or spine to itchy skin rashes, to swelling in the fingers and toes. Previous studies have examined these skin and musculoskeletal manifestations in connection with psychological issues that patients also develop, such as sleep disturbances, fatigue, anxiety, and depression. But how often, and in what ways, do these symptoms connect? Are any specific objective measures of the disease causal toward psychological correlates, for instance?
To better understand those potential connections in the symptomatic progressions of psoriatic arthritis, the authors of this study recruited 141 patients from outpatient clinics in Norway. Both sleep disturbances and fatigue were measured on a scale from 0 to 10 and were defined as being present when a patient scored greater than or equal to 5. Anxiety and depression, on the other hand, were evaluated using a questionnaire, and patients were measured on a scale from 1 to 3, with 1 being classified as having no anxiety or depression.
The study also measured the patients’ demographic data, including age, gender, body mass index, employment status, and general level of activity.
Here’s what was found: of the psoriatic arthritis patients in this study, sleep disturbances were found in 38 percent, while fatigue was present in 44.5 percent of patients. 32.8 percent of patients experienced moderate anxiety or depression, and 5.1 experienced extreme anxiety or depression.
Now an interesting finding here was these results didn’t appear to be linked to any one specific skin or musculoskeletal manifestation of psoriatic arthritis, meaning there was no direct a-to-b linkages to the development of sleep disturbances, fatigue, or anxiety and depression.
But that’s telling in and of itself, because what the data don’t suggest in a singular cause do indicate that assessing any one physical symptom preferentially in patients with psoriatic arthritis is not going to be as relevant to understanding the psychological sequelae, compared to measuring the level of pain and discomfort those physical symptoms cause.
On discovered association, increased pain, fatigue, and impaired physical functions were independently associated with increased sleep disturbances. Likewise, increased pain, sleep disturbances, and anxiety or depression were independently associated with fatigue. But fatigue was only independently associated with anxiety or depression.
As for the independent variables measured, the authors found that demographics and activity played no role in the patients’ psychological symptoms.
One of the big takeaways for the study authors was the need for clinicians to take into account the fact that sleep disturbances, fatigue, and anxiety or depression are prevalent in patients with psoriatic arthritis, and that focusing only on objective measures of disease activity in follow-up care could give a false impression of the burden of this disease. They also underscored the importance of measuring pain and understanding how these psychological symptoms actually develop within the disease course, which can be instrumental in the design of effective treatment plans.
For ReachMD, this is Dr. Matt Birnholz. Find more details of this report in the Arthritis Research and Therapy journal, and look for the recent article focusing on sleep disturbances, fatigue, and depression in patients with psoriatic arthritis. Thanks for listening.
You’ve been listening to Beyond Skin Deep: Impacts of Psoriatic Arthritis, sponsored by Lilly. To access other episodes in this series, visit ReachMD.com/beyondskindeep, where you can Be Part of the Knowledge.
- Host: Matt Birnholz, MD
Could psoriatic arthritis contribute to sleep disturbances, fatigue, anxiety, or depression?