Inadequate sleep as a limiting factor in achieving remission in patients with rheumatoid arthritis

Introduction

Good sleep has a restorative effect at the cellular level and helps maintain the body's homeostasis.

Objectives

Given our clinical experiences, we propose that sleep quality should be evaluated in patients with rheumatoid arthritis. Poor sleep quality should be considered as a factor that may impact clinical outcomes in patients with rheumatoid arthritis.

Materials and methods

We researched medical literature on clinical and physiological pathways associated with sleep quality.

Results

There is evidence that interleukin-6 and tumor necrosis factor have a role in inflammatory and immune imbalance as well as in sleep disturbance in patients with rheumatoid arthritis, which leads to the chronic inflammatory process seen in these patients. Most patients with rheumatoid arthritis report sleep problems, be it insomnia or other complaints of non-refreshing sleep. Lack of sleep or poor sleep patterns in these patients further compromise their quality of life. In patients with RA, aetiologies such as restless leg syndrome (RLS), sleep apnoea syndrome, and Temporomandibular Joint Dysfunction (TMJ) syndromes might contribute to sleep disturbances. This lack of restful sleep might limit our goal, as treating physicians, to achieve remission states in these patients.

Conclusions

It is our opinion that sleep quality evaluation must be addressed, monitored, and treated as part of the management of patients with RA. Bad sleep adds an additional burden to disease activity in patients with RA, besides, it limits patients’ possibility of achieving disease remission.