Sleep disorders in RA, axSpA and PsA are common despite good disease activity control-direct comparison of sleep quality and its risk factors using MDHAQ and PSQI.
Polak D, Kolasińska M, et al. • Clinical rheumatology • 2026
Sleep disorders are common in RA, axSpA, and PsA despite well-controlled disease activity, highlighting the role of non-inflammatory factors, and the MDHAQ could serve as a screening tool for identifying poor sleep quality.
Key Findings
Results
Poor sleep was highly prevalent across all three rheumatic diseases, affecting the majority of patients in each group.
Prevalence of poor sleep (PSQI score > 5) was 61.5% in PsA, 63.7% in RA, and 66.7% in axSpA.
No statistically significant differences in PSQI total scores or sleep domains were identified between the three disease groups.
Study included 129 patients with RA, 81 with PsA, and 103 with axSpA from the PolNorRHEUMA registry.
Total sample was 313 adult patients in a cross-sectional study design.
Results
Sleep disturbances remained highly prevalent despite patients being in remission or low disease activity.
The median disease activity scores for all three groups corresponded to remission or low disease activity.
This finding highlights the role of non-inflammatory factors in the pathophysiology of sleep disturbances in these conditions.
Disease activity, pain, and other clinical variables were recorded alongside sleep assessments.
Results
Independent risk factors for poor sleep differed across disease types, with female sex identified in RA, and older age and anxiety identified in PsA.
Female sex was an independent risk factor for poor sleep in RA patients.
Older age and anxiety were independent risk factors for poor sleep in PsA patients.
No specific independent risk factors were reported as significant for axSpA in the abstract.
MDHAQ variables assessed included sleep, anxiety, depression, and stress.
Results
The MDHAQ sleep-related question demonstrated strong correlation with PSQI scores across all three disease groups.
Correlation coefficients between the MDHAQ sleep-related question and PSQI score were 0.53 for RA, 0.65 for PsA, and 0.55 for axSpA (p < 0.01 for all).
In linear regression analysis, a significant association between MDHAQ sleep question and PSQI was maintained in RA and axSpA.
The PSQI uses a threshold score greater than 5 to indicate poor sleep quality.
Authors conclude the MDHAQ could serve as a screening tool for identifying patients with poor sleep quality needing further evaluation.
Methods
The study provides a novel direct comparison of sleep disturbances and associated risk factors across RA, axSpA, and PsA simultaneously.
Both the MDHAQ and PSQI were used, allowing assessment of their correlation as screening instruments.
The study assessed demographics, disease activity, pain, and clinical variables alongside sleep measures.
Data were drawn from the PolNorRHEUMA registry in a cross-sectional design.
The MDHAQ includes queries concerning sleep, anxiety, depression, and stress in addition to disease activity measures.
What This Means
This research suggests that sleep problems are extremely common among people with three types of inflammatory arthritis — rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA) — affecting roughly two-thirds of patients in each group. Importantly, this high rate of poor sleep persisted even in patients whose arthritis was well-controlled with medication (in remission or low disease activity), suggesting that inflammation alone does not explain why so many patients sleep poorly. The study found no significant differences in sleep quality between the three disease types.
The research also identified that different factors drove poor sleep in different conditions: being female was a risk factor in RA, while older age and anxiety were risk factors in PsA. This suggests that addressing sleep problems may require individualized approaches that go beyond just treating the underlying joint disease, and that psychological factors like anxiety may play an important role.
A practical finding from this study is that a single sleep-related question from a standard rheumatology questionnaire (the MDHAQ) correlated strongly with the more detailed Pittsburgh Sleep Quality Index (PSQI) across all three diseases. This research suggests that rheumatologists could use routine patient questionnaires they already administer to flag patients who may be experiencing poor sleep and refer them for further evaluation, without needing a separate, lengthy sleep assessment tool.
Polak D, Kolasińska M, Wilk M, Dyczek &, Korkosz M, Guła Z. (2026). Sleep disorders in RA, axSpA and PsA are common despite good disease activity control-direct comparison of sleep quality and its risk factors using MDHAQ and PSQI.. Clinical rheumatology. https://doi.org/10.1007/s10067-025-07892-0