The effect of disease-modifying agents on sleep and quality of lifein patients with rheumatoid arthritis in the geriatric age population

Objective-Hypothesis: It has been reported that sleep quality is worse in rheumatoid arthritis (RA) patients than healthy controls and it is more difficult to achieve a satisfactory quality of life after treatment with age. However, sleep and life data on its quality is scarce in the geriatric age group with RA. In this study, our aim is to assess the quality of life and sleep in the geriatric age population and to analyze the effect of disease-modifying agents on sleep and quality of life. Method: Thirty-four patients in the geriatric age group, diagnosed with RA according to the 2010 ACR/EULAR classification criteria and 30 people over 65 years old without any rheumatic disease as the control group are included in the study. Age, gender, smoking/alcohol use, comorbidity, marital status, employment status, education status, disease-modifying drug use, steroid use, lung involvement, DAS-28, anti-CCP, and rheumatoid factor levels of the patients were recorded. Sleep quality was evaluated with the Pittsburg sleep quality index and quality of life with SF-36 (Short Form-36). Data were analysed by using SPSS 21.0. Parametric/non-parametric tests and Spearman/Pearson correlation analysis were applied for the data according to the distribution. A p-value of <0.05 was considered statistically significant. Results: 67,6% of rheumatoid arthritis patients were women and the mean age was 72,8±6,7. While the rate of patients with RA diagnosed in the geriatric age group with poor sleep quality before treatment was 67,6%, this rate was 26,5% after treatment. There was no statistically significant difference between the groups in terms of sleep quality in terms of gender, smoking-alcohol use, marital status, employment status, educational status, and comorbid diseases. There was a statistically significant difference before and after treatment in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and scores for sleep disturbance. The mean steroid dose and DAS-28 were higher in patients with poor sleep quality than in patients with good sleep quality. Patients with poor sleep quality had lower mean physical function, pain, general health, social function, emotional role difficulties, and energy/vitality values than patients with good sleep quality. A negative correlation was found between the total Pittsburgh sleep quality index and the quality of life components assessed by SF-36. The best cut-off value for sedimentation was 47,5 mm/hour and the DAS-28 score was 5,1 in distinguishing good and poor sleep quality. Conclusion: In patients with RA diagnosis of geriatric age, both sleep and quality of life improved after treatment. Age and high disease activity correlate with poor sleep and quality of life. Disease-modifying agents are used safely in the geriatric age group. In this age group, patients should be regularly evaluated in terms of sleep and quality of life and appropriate treatment should be provided.