PsA patients often suffer from untreated sleep issues
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Joint pain and decreased daily physical activity can contribute to patients with psoriatic arthritis having trouble falling or staying asleep, but the sleep issues often are overlooked and go untreated, according to researchers.
Healio spoke with Brent A. Luedders, MD, a second-year fellow at the University of Nebraska Medical Center, who emphasized the need for doctors to “ask the right questions” when treating patients with PsA who experience sleep problems.
In a typical PsA clinical visit, the patient and provider may spend the majority of the appointment discussing disease control with antiinflammatory and immunosuppressive medication regimens, said Luedders. This can take time from discussing sleep problems or other factors that may affect psoriatic arthritis. Patients may be seeing a primary care physician or other specialists for any comorbid diagnoses, which can further lessen the time focused on their PsA. Luedders recommends that patients maintain a strong relationship with a primary care provider to best address their overall health.
“It is not uncommon that patients with painful musculoskeletal conditions suffer from sleep disruption and poor sleep quality, which at times may be related to poorly controlled symptoms of PsA and at other times may be secondary to extraneous factors separate from PsA,” said Luedders. “In order to best address sleep problems in patients with PsA, it is important that providers not only consider PsA as a cause but also consider the roles that these other conditions may be playing.”
Treatment will vary between patients depending on whether their sleep issues are a direct result of PsA or of another comorbid condition such as metabolic syndrome, obesity, anxiety and depression. Luedders said he does not routinely prescribe medications directly targeted at sleep, but regularly speaks with patients about “sleep hygiene,” which includes taking steps such as setting a regular sleep and wake schedule, exercising regularly during daytime hours, avoiding large meals and caffeine prior to bedtime and limiting screen time in the hours before going to sleep.
“There are absolutely ways that patients with PsA can improve their sleep without medications,” said Luedders. “In general, I recommend that all patients with sleep problems work on these non-pharmacologic aspects prior to using medications specifically targeted at sleep, which may have undesirable side effects.”
Screening patients for sleep issues can help narrow down what is causing poor sleep. Luedders said if a patient shows no sign of active inflammation but continues to suffer from joint and musculoskeletal pain, it could be a sign of poor sleep. In such patients, mental health issues or obstructive sleep apnea may be contributing factors. As obesity is associated with both PsA and obstructive sleep apnea, Luedders said screening for and treatment of obstructive sleep apnea should be prioritized.
“The medical community continues to gain a better understanding that sleep, mood, and pain perception are highly inter-related domains, and that problems in one of these areas can have significant impacts on the others,” said Luedders. “We oftentimes see that patients with poor sleep can have amplified pain responses that can lead them to experience pain in their joints and muscles that is not being driven by active inflammation, but rather is related to changes in how their brain and body sense painful signals. Therefore, this type of pain does not typically respond to changes in PsA medications but rather requires addressing the underlying sleep problems.”
Medications that treat PsA may lead to side effects in patients that can affect their gastrointestinal symptoms or mood disorders, which can impair sleep quality. Luedders encouraged anyone affected by sleep issues to work with their primary care provider to address the issue and adjust any medications as needed.
“Ultimately, my hope is that by control of the underlying inflammatory disease and associated symptoms, patients will achieve better sleep quality,” he said. “For this reason, I do not view any one specific PsA medication as being the ‘best’ for sleep, but rather, the best medication is the one that best controls an individual patient’s arthritis.”
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