Sleep Disturbances, Fatigue, and Depression Common Among Patients With Psoriatic Arthritis

a sleepless man looks at his alarm clock at night
Researchers explored the occurrence of sleep disturbances, fatigue, and anxiety/depression in patients with psoriatic arthritis.

Sleep disturbances, fatigue, and mood disorders are commonly reported among patients with psoriatic arthritis (PsA), according to study results published in Arthritis Research & Therapy. However, no demographic or objective disease measures were found to be independently associated with these symptoms.

Previous studies reported that sleep disturbances, fatigue, and mood disorders are common in patients with PsA and these may be influenced by skin and musculoskeletal manifestations of PsA.

The objective of the current study was to explore the prevalence of sleep disturbances, fatigue, and mood disorders in patients with PsA and investigate the associations with demographic variables and disease measures.

The cross-sectional study included patients with PsA from Norwegian PsA outpatient clinics with available data for sleep disturbances, fatigue, and depression. Sleep disturbances and fatigue were defined by scores on a numeric rating scale (≥5; range, 0-10), and anxiety/depression was assessed using a questionnaire (range, 1-3; 1 was defined as no anxiety/depression). Researchers used univariate and linear regression analysis to determine associations.

Of 137 patients with PsA (mean age, 52.3 years; 49.6% men) included in the study, the prevalence of sleep disturbances was 38.0% (n=52), fatigue 44.5% (n=61), moderate anxiety or depression 32.8% (n=45), and extreme anxiety or depression 5.1% (n=7).

According to the modified Health Assessment Questionnaire, increased pain (adjusted B, 0.031; 95% CI, 0.006-0.056; P =.015), fatigue (adjusted B, 0.434; 95% CI, 0.230-0.638; P =.000), and impaired physical function (adjusted B, 1.753; 95% CI, 0.225-3.281; P =.025), were independently associated with increased sleep disturbances. Similarly, increased pain (adjusted B, 0.025; 95% CI, 0.003-0.047; P =.024), sleep disturbances (adjusted B, 0.339; 95% CI, 0.183-0.495; P <.001), and anxiety/depression (adjusted B, 1.242; 95% CI, 0.655-1.830; P <.001) were independently associated with fatigue. However, only fatigue was independently associated with anxiety/depression (adjusted B, 0.106; 95% CI, 0.054-0.157; P <.001).

None of the demographic or disease activity measures reflecting the inflammatory skin and the musculoskeletal disease process was associated with sleep disturbances, fatigue, and anxiety/depression.

The study had several limitations, including the cross-sectional design and the inclusion of many independent variables.

“Our data [highlight] the need for clinicians to be aware of the presence and importance of these domains, judged by patients to be of particular importance, and take them into account when treating patients [with] PsA because focusing only on objective measures reflecting disease activity in the follow-up of patients [with] PsA would give a false impression of the burden of the disease for the patients [with] PsA,” the researchers concluded.

Disclosure: This study was supported by Pfizer Norway ID. Please see the original reference for a full list of authors’ disclosures.


Haugeberg G, Hoff M, Kavanaugh A, Michelsen B. Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates. Arthritis Res Ther. 2020;22(1):198.