Factors associated with the inflammatory process in pain in ankylosing spondylitis

Abstract

Introduction sleep disorders, closely related to any chronic pain process, are frequent among patients with rheumatic diseases, mainly ankylosing spondylitis (AS). Our study aimed to determine the association between sleep disturbances and the inflammatory process in pain in AS patients compared with lower back pain (LBP) patients. We have additionally examined factors associated with sleep disorders among AS patients. Methods we conducted a cross-sectional study among AS patients. Sociodemographic data, patient reported outcomes and disease characteristics were recorded. Sleep was assessed using the medical outcomes study sleep scale measure (MOS-SS). For psychological assessment, Beck anxiety (BAI) and depression index (BDI) was used. A multivariate logistic regression was performed to identify factors associated with sleep disorders. Results the study included 50 patients with AS and 40 patients with low back pain. The most common affected domains among AS patients were inadequacy, sleep disturbance, and daily somnolence. The MOS-SS index was significantly higher in the AS group than in the control group (p<0.001). Sleep disorder was associated with age, female gender, analphabetism, patient-reported outcomes (all p<0.05), but was not associated with profession, comorbidities and smoking habits. In multivariate analysis, factors associated with sleep disruption were the duration of morning stiffness (MS), disease activity, bath ankylosing spondylitis metrology index (BASMI), ASQol, as well as anxiety and depression (odds ratio: 5.4(CI 95% 1.6-18.3), 9.9 (CI95%1.1-86); 6 (CI95%1.1-32); 13 (CI 95% 1.4-143.8); 15.7 (CI 95% 2.6-94.3); 14 (CI 95% 2-105.7) respectively, p<0.05 for each). Conclusion our study highlighted the importance of sleep disorders among patients with AS with a predilection for inadequacy, sleep disturbance, and daily somnolence. Factors associated with sleep disruption were high disease activity, a longer duration of MS, an altered function and quality of life as well as anxiety and depression.

Prevalence of sleep disturbance in patients with ankylosing spondylitis: a systematic review and meta-analysis

“…The findings of other studies also indicate the negative impact of more severe disease activity on the sleep quality of AS patients [6,14,18,21,37]. More disease activity causes increased structural damage and disruption of spine mobility, which can cause difficulty in changing position while sleeping and thus disturb the patients' sleep [18,40]. Also, the findings indicate a significant positive correlation between sleep disorder scores and metrics (measurements related to the pelvis and spine) measured by Bath Ankylosing Spondylitis Metrology Index (BASMI) [6,19,28].…”

“…In this regard, the study of Tymms et al showed that patients with a more severe AS experience the symptoms of insomnia seven times more [10]. The findings of other studies also indicate the negative impact of more severe disease activity on the sleep quality of AS patients [6,14,18,21,37]. More disease activity causes increased structural damage and disruption of spine mobility, which can cause difficulty in changing position while sleeping and thus disturb the patients' sleep [18,40].…”

“…Night pain is one of the prominent features of AS disease, which can affect the quality of sleep among patients [16]. The findings of existing literature indicate a significant relationship between pain experience and sleep quality disruption [18,20,22,37,38]. In a study by Nie et al, nighttime back pain was one of the key factors resulting in sleep disturbance.…”

“…The findings from previous research indicate that patients with AS suffer from more sleep disorders than healthy individuals [14][15][16]. Patients with AS are affected by various sleep disorders, including sleep onset and continuation disorders, restless leg syndrome, and obstructive sleep apnea (OSA) [10,14,[16][17][18]. Nevertheless, previous research findings present different sleep disorder prevalences among AS patients.…”

Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis

“…Furthermore, sleep disturbances were shown to be associated with high disease activity and impaired function in patients with axSpA. 49 50 In that line, systemic inflammation and elevated levels of cytokines such as TNFi, IL-6 and IL-1ß were shown to increase inflammatory and neuropathic pain, being a central factor in low back pain and associated with pain severity. 51 …”