Sleep Disturbances, Diabetes Common in Psoriatic Arthritis

SAN FRANCISCO — Patients with psoriatic arthritis had significantly greater prevalences of insomnia, restless leg syndrome, and diabetes than did psoriasis patients or controls in a large single-center comparison.

The psoriatic arthritis patients also had a greater mean body mass index than either comparison group, Dr. Kristina Callis Duffin reported at the annual meeting of the American Academy of Dermatology.

Dr. Duffin of the University of Utah, Salt Lake City, presented the results of a questionnaire survey of 188 patients with psoriasis, 86 others with concomitant psoriatic arthritis and psoriasis, and 169 nonpsoriatic controls who presented to the university's department of dermatology for reasons other than psoriasis.

The psoriatic arthritis patients had a mean age of 57 years, compared with 53 years for the psoriasis patients and 46 years for the dermatologic controls. The psoriatic arthritis patients were heavier, too, with a mean body mass index of 30.6 kg/m

The prevalence of diabetes was 23.3% among psoriatic arthritis patients, 9% in psoriasis patients, and 3% in controls. A diagnosis of restless leg syndrome was carried by 15.1% of the psoriatic arthritis cohort, 6.4% of those with psoriasis, and 4.1% of controls.

The psoriatic arthritis group scored significantly worse (9.0) on the Pittsburgh Sleep Quality Index (PSQI) than patients with psoriasis (7.0) or controls (7.1), after adjusting for BMI and age. The PSQI is a validated instrument encompassing seven sleep parameters. The psoriatic arthritis patients scored significantly worse than the other groups on three parameters: sleep quality, latency, and disturbances. Notably, all three groups of dermatology patients had mean PSQIs well in excess of 5, the accepted cutoff for poor sleep, Dr. Duffin noted.

Patients with psoriatic arthritis also had significantly higher scores on the Global Fatigue Scale than the other participants. The psoriasis patients and controls didn't differ significantly in terms of fatigue scores or PSQI ratings, nor did the three groups differ significantly in rates of sleep apnea or narcolepsy.

The psoriatic arthritis patients and those with psoriasis scored similarly high on itch ratings. The Utah study was conducted free of commercial support. It was undertaken in follow-up to an earlier study Dr. Duffin presented last year at an international investigative dermatology meeting in Kyoto, Japan.

In the earlier study, she surveyed 428 patient members of the National Psoriasis Foundation and found by far the strongest predictor of sleep disturbance in psoriasis patients was concomitant psoriatic arthritis. Lesser predictors were the degree of psoriasis-related itching and pain and the disease's self-reported impact upon emotional well being.

The link between sleep problems and psoriatic arthritis is worthy of further investigation in light of evidence of associations between psoriatic disease and cardiovascular disease and diabetes. The common thread may be underlying systemic inflammation, Dr. Duffin said.

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SAN FRANCISCO — Patients with psoriatic arthritis had significantly greater prevalences of insomnia, restless leg syndrome, and diabetes than did psoriasis patients or controls in a large single-center comparison.

The psoriatic arthritis patients also had a greater mean body mass index than either comparison group, Dr. Kristina Callis Duffin reported at the annual meeting of the American Academy of Dermatology.

Dr. Duffin of the University of Utah, Salt Lake City, presented the results of a questionnaire survey of 188 patients with psoriasis, 86 others with concomitant psoriatic arthritis and psoriasis, and 169 nonpsoriatic controls who presented to the university's department of dermatology for reasons other than psoriasis.

The psoriatic arthritis patients had a mean age of 57 years, compared with 53 years for the psoriasis patients and 46 years for the dermatologic controls. The psoriatic arthritis patients were heavier, too, with a mean body mass index of 30.6 kg/m

The prevalence of diabetes was 23.3% among psoriatic arthritis patients, 9% in psoriasis patients, and 3% in controls. A diagnosis of restless leg syndrome was carried by 15.1% of the psoriatic arthritis cohort, 6.4% of those with psoriasis, and 4.1% of controls.

The psoriatic arthritis group scored significantly worse (9.0) on the Pittsburgh Sleep Quality Index (PSQI) than patients with psoriasis (7.0) or controls (7.1), after adjusting for BMI and age. The PSQI is a validated instrument encompassing seven sleep parameters. The psoriatic arthritis patients scored significantly worse than the other groups on three parameters: sleep quality, latency, and disturbances. Notably, all three groups of dermatology patients had mean PSQIs well in excess of 5, the accepted cutoff for poor sleep, Dr. Duffin noted.

Patients with psoriatic arthritis also had significantly higher scores on the Global Fatigue Scale than the other participants. The psoriasis patients and controls didn't differ significantly in terms of fatigue scores or PSQI ratings, nor did the three groups differ significantly in rates of sleep apnea or narcolepsy.

The psoriatic arthritis patients and those with psoriasis scored similarly high on itch ratings. The Utah study was conducted free of commercial support. It was undertaken in follow-up to an earlier study Dr. Duffin presented last year at an international investigative dermatology meeting in Kyoto, Japan.

In the earlier study, she surveyed 428 patient members of the National Psoriasis Foundation and found by far the strongest predictor of sleep disturbance in psoriasis patients was concomitant psoriatic arthritis. Lesser predictors were the degree of psoriasis-related itching and pain and the disease's self-reported impact upon emotional well being.

The link between sleep problems and psoriatic arthritis is worthy of further investigation in light of evidence of associations between psoriatic disease and cardiovascular disease and diabetes. The common thread may be underlying systemic inflammation, Dr. Duffin said.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Patients with psoriatic arthritis had significantly greater prevalences of insomnia, restless leg syndrome, and diabetes than did psoriasis patients or controls in a large single-center comparison.

The psoriatic arthritis patients also had a greater mean body mass index than either comparison group, Dr. Kristina Callis Duffin reported at the annual meeting of the American Academy of Dermatology.

Dr. Duffin of the University of Utah, Salt Lake City, presented the results of a questionnaire survey of 188 patients with psoriasis, 86 others with concomitant psoriatic arthritis and psoriasis, and 169 nonpsoriatic controls who presented to the university's department of dermatology for reasons other than psoriasis.

The psoriatic arthritis patients had a mean age of 57 years, compared with 53 years for the psoriasis patients and 46 years for the dermatologic controls. The psoriatic arthritis patients were heavier, too, with a mean body mass index of 30.6 kg/m

The prevalence of diabetes was 23.3% among psoriatic arthritis patients, 9% in psoriasis patients, and 3% in controls. A diagnosis of restless leg syndrome was carried by 15.1% of the psoriatic arthritis cohort, 6.4% of those with psoriasis, and 4.1% of controls.

The psoriatic arthritis group scored significantly worse (9.0) on the Pittsburgh Sleep Quality Index (PSQI) than patients with psoriasis (7.0) or controls (7.1), after adjusting for BMI and age. The PSQI is a validated instrument encompassing seven sleep parameters. The psoriatic arthritis patients scored significantly worse than the other groups on three parameters: sleep quality, latency, and disturbances. Notably, all three groups of dermatology patients had mean PSQIs well in excess of 5, the accepted cutoff for poor sleep, Dr. Duffin noted.

Patients with psoriatic arthritis also had significantly higher scores on the Global Fatigue Scale than the other participants. The psoriasis patients and controls didn't differ significantly in terms of fatigue scores or PSQI ratings, nor did the three groups differ significantly in rates of sleep apnea or narcolepsy.

The psoriatic arthritis patients and those with psoriasis scored similarly high on itch ratings. The Utah study was conducted free of commercial support. It was undertaken in follow-up to an earlier study Dr. Duffin presented last year at an international investigative dermatology meeting in Kyoto, Japan.

In the earlier study, she surveyed 428 patient members of the National Psoriasis Foundation and found by far the strongest predictor of sleep disturbance in psoriasis patients was concomitant psoriatic arthritis. Lesser predictors were the degree of psoriasis-related itching and pain and the disease's self-reported impact upon emotional well being.

The link between sleep problems and psoriatic arthritis is worthy of further investigation in light of evidence of associations between psoriatic disease and cardiovascular disease and diabetes. The common thread may be underlying systemic inflammation, Dr. Duffin said.

ELSEVIER GLOBAL MEDICAL NEWS