الفهرس 
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Abstract
CONCLUSION
F
unctional activities of daily living and sleep quality are strongly correlated with disease activity in RA patients and they are multifactorial in origin and related to pain, fatigue, depression, educational level and physical deformity.
RECOMMENDATIONS
G
iven our results and the noted associations of disease activity side by side to above mentioned factors, there is a pressing need for them to be included in regular examination and follow up and it is not enough to control one factor, all factors are inter-correlated and they should be managed equally.
There is a need for evidence-based algorithm on implementation of sedatives and antidepressants in treatment of RA.
There is also a need for incorporation of therapeutic patient education and expanding knowledge of the patients about their nature of the disease, importance of compliance, follow up visits, and self-management strategies.
We also encourage early reach to biologics by needed patients and minimize their hold up.
Further research is also necessary on the impact of bDMARDs on functional status, sleep quality, pain, fatigue, and depression in RA patients.
SUMMARY
Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammatory arthritis as well as extra-articular involvement.
Most common clinical presentation of RA is polyarthritis of small joints of hands: proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints and wrist. Some patients may present with monoarticular joint involvement. Most commonly joint involvement occurs insidiously over a period of months, however, in some cases, joint involvement may occur over weeks or overnight. Other commonly affected joints include elbows, shoulders, hips, knees, ankles and metatarsophalangeal (MTP) joints. Stiffness in the joints in the morning may last up to several hours, usually greater than an hour. In addition to articular deterioration, constitutional symptoms (eg, fatigue, malaise, morning stiffness, weight loss, and low-grade fever) may be present.
Our aim of the work was to assess the relation between DAS28 (ESR) score with ADL and sleep quality in RA patient.
This study is a Cross Sectional Study Settled in Physical Medicine, Rheumatology and Rehabilitation (PRR) outpatient clinic of Ain Shams University hospital. Data were collected once.
When studying the relation of disease activity using DAS28 (ESR) scale with the results of the functional assessment scores, we found a strong relation between disease activity and functional affection reflected by a highly significant relation between DAS28 scores and BADL score, and a significant relation between DAS28 scores and IADL score. We also found a strong correlation between pain and functional affection in RA patients reflected by a highly significant correlation between VAS score and both BADL and IADL.
When assessing the relation between disease activity and sleep quality elements, a strong relation was detected and affection of many elements of sleep scale reflected by a highly significant relation between DAS28 score and restless sleep, feeling rested upon waking up in the morning, troubles falling asleep, and waking up during the sleep and inability to sleep again.
While there was a significant relation between DAS28 score and waking up short of breath or with a headache, and there was no significant relation between total score of MOSS scale and DAS28.
When we conducted history taking and clinical examination to our patients, we found depressive symptoms (feelings of sadness, tearfulness, emptiness or hopelessness, angry outbursts, irritability or frustration, loss of interest or pleasure in most or all normal activities) in most of our patients. This sheds a light on the importance of screening of depression among RA patients and early treatment as soon as possible.
It was not only important to study the functional affection in RA, but also important to detect physical factors contributing to this affection. Thus, we studied the abnormalities in X- rays in RA patients and we found, periarticular osteopenia and erosions. We found a highly significant relation between duration of RA and incidence of both periarticular osteopenia and erosions, reflecting that the longer the RA duration, the more findings found in X-ray which means that disease duration plays an important role in radiological findings in RA patients.
Regarding the visible physical affection like deformity, we found that more than half of our patients had visible deformity and there was a highly significant relation between the disease duration and incidence of deformity indicating disease duration is an important factor in developing deformity.
In our study, we also investigated the relation of current treatments taken by RA patients with their functional status, sleep quality, and disease activity and we found no relation. This is reflected statistically by no significant relation (P-value > 0.05) between neither csDMARD nor bDMARD therapy and BADL, IADL, and MOSS scale scores. The cause of this irrelativity might be explained by the more aggressive nature of cases among our study population which is a consequence to recruitment from a tertiary care hospital.
Finally, the study has some limitations that need to be addressed. First, the cross-sectional data used in the analysis restricts causal conclusions about the directionality of the relationships between disease activity, sleep, depression, pain severity, and functional disability thus, longitudinal study is needed to help detecting causal relationship. Second, the majority were women, which somehow affects generalization of study results. Third, late intake of biologics and more aggressive nature of cases among study population may have led to misrepresentation of effects of biologics on patients’ functional status and quality of life. Lastly, these patients were recruited while presenting to physical medicine, rheumatology and rehabilitation clinic, this may lead to underestimation of actual results due to reporting bias.
Functional activities of daily living and sleep quality are both affected in RA patients and they are multifactorial in origin and related to disease activity, pain, depression, educational level and physical deformity.