Association Between Sleep Disturbance and Subsequent Pain Interference in Patients With Early Rheumatoid Arthritis

Abstract

Objective: This study investigated whether sleep disturbance can predict the extent to which pain interferes with daily functioning in patients with early rheumatoid arthritis (RA).

Methods: Data were from adults with early RA (joint symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort between 2016 and 2023. Participants underwent standardized clinical assessments and completed Patient-Reported Outcomes Measurement Information System measures at 0, 6, 12, 18, and 24 months to assess sleep disturbance (primary predictor) and pain interference (primary outcome). Linear mixed-effects models were used to estimate crude and adjusted (age, sex, body mass index, education, income, smoking status, comorbidities, disease activity, treatment, and depression) effects of sleep disturbance on pain interference over the 24-month study period. The analysis was lagged so that repeat measures of sleep disturbance at 0, 6, 12, and 18 months were evaluated as predictors of pain interference 6 months later at 6, 12, 18, and 24 months' follow-up.

Results: The analysis included 502 patients with early RA. At baseline, the sample was 68% female and 81% White; the mean age was 56 (SD 14) years, and the mean disease duration was 5.4 (SD 2.9) months. The unadjusted and adjusted linear mixed-effects models revealed a significant association between sleep disturbance and subsequent pain interference scores, indicating that worse sleep six months prior was associated with greater pain interference at the following six-month evaluation.

Conclusion: These findings underscore the importance of addressing sleep disturbances as part of pain management strategies soon after RA diagnosis. Identifying and targeting problematic sleep disturbances early on may help improve long-term pain outcomes.

Figure 1

Flowchart of participants fulfilling eligibility criteria with PROMIS data available at each time point. CATCH, Canadian Early Arthritis Cohort; PROMIS, Patient‐Reported Outcomes Measurement Information System.