Study Pertaining To Mutual Relations Of Sleep, Anxiety, Depression And Clinical Characteristics Of Ankylosing Spondylitis And Intervention With Thalidomide

PART I Sleep disturbances are associated with increased pain, disease activity,anxiety and depression in ankylosing spondylitis.Background and Objective. The relation between pain and sleep quality is two-way:sleep disorders can increase pain, which in turn may cause sleep disorders. Pain is a coresymptoms of AS, therefore, it is unsurprising that the sleep disorders and AS can co-exist.This cross-sectional study was designed to evaluate sleep disturbances and theirassociation with pain, disease specific variables, functional status, covering psychologicalstatus in AS patients.Methods. Patients were recruited from rheumatology department and completed a batteryof questionnaires from May2010, to November2010. Blood samples were taken tomeasure C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR). The associationamong sleep, pain, disease activity, functional status, depression and anxiety were assessedusing Pearson/Spearman correlations and Logistic regressions.Results. Three hundred and fourteen consecutive patients with AS (234men,80women)were included in the study. The mean age of patients was27.6±8.3years, and the meandisease duration was6.1±4.9years.(2) The mean PSQI, SDS and SAS score of patientswere6.6±3.6,47.3±10.5, and48.4±8.1, respectively. A total of58.6%(184/314) of our ASparticipants had poor sleep.(3) Sleep disturbances were associated with age, morningstiffness, Bath Ankylosing Spondylitis Functional Index (BASFI), pain, Bath AnkylosingSpondylitis Disease Activity Index (BASDAI), ESR, CRP, depression, anxiety (allP<0.001).(4) Sleep disturbances were not associated with disease duration,fingertip-to-floor distance and Bath Ankylosing Spondylitis Metrology Index (BASMI)(P>0.05).(5) Poor sleep patients with had significantly higher levels of morning stiffness,BASFI, nocturnal pain, total back pain, peripheral pain/swelling, BASDAI, ESR, CRP,SDS and SAS(P<0.05) than good sleep patients. With regard to age, disease duration,fingertip-to-floor distance and BASMI score, there were not statistically significant difference between the two groups (P>0.05).(6) Logistic regression analysis revealed thatanxiety was most powerful predictor of sleep disturbances (P=0.01).Conclusions. The prevalence of sleep disturbances in AS patients is higher than it isgenerally thought to be. Age, morning stiffness, disease activity, pain severity, BASFI,depression and anxiety had a considerable effect on sleep disturbances. Anxiety was mostpowerful predictor of sleep disturbances. These results highlight sleep disturbances andpsychiatric disorders could not be ignored in the management of AS. PART Ⅱ Influence of Psychological Status on Disease Parameters in AnkylosingSpondylitis Patients with Normal CRP/ESR: A Cross-sectional StudyAbstractBackground and Objective. Anxiety and depression have a closely relationship with pain,and they are often co-morbidity with AS. Despite performance of the inflammatory activityhave been disappear, some AS patients continue to rate pain. Therefore, there is a need fortargeted psychological status among those AS patients. The concept of disease activity ofAS is rather complex. It is only50-70%of AS patients with active disease have anincreased level of CRP and ESR. In spite of the markers of disease activity (CRP and ESR)had limitations to represent all active inflammation, we choose them for their simplicityand feasibility in clinical practice. This study was designed to evaluate the associationsbetween psychological status and disease parameters in ankylosing spondylitis (AS)patients with normal CRP and ESR..Methods. Patients with normal CRP and ESR were screened from the previous survey, andthen, we kept on recruiting Patients with the same characteristics to complete the secondpart of the study in rheumatology department from October2010to June2011. ZungSelf-rating anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), pain-visualanalogue scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),and Functional Index (BASFI), and Metrology Index (BASMI), fingertip-to-floor distance,duration of morning stiffness, were used to assess psychological status and diseaseparameters respectively. Mann-Whitney U test and t test was used in independent groupsfor parametric variables, whereas the Spearman correlation analysis was used to assess correlation between parametric variables. Comparision of SAS and SDS scores in ASpatients and normative values was evaluated by t test.Results.(1) Of the166patients (50women,116men), mean age was27.6±8.1years, andmean disease duration was5.3±4.5years.(2) Anxiety, depression and mixed anxiety anddepression were found in38%,35.5%and26.5%of our patients.(3) SAS and SDS scoreswere significantly higher than normative values of Chinese population (P=0.000).(4)Self-report disease parameters (pain, BASDAI and BASFI) were correlated with anxietyand depression (P <0.05), while objective characteristics (fingertip-to-floor distance andBASMI) were not correlated with them (P>0.05).(5) Anxious and depressed patientsubgroups had significantly higher levels of pain, BASDAI and BASFI than non-anxiousand non-depressed subgroup (P <0.05). No statistical difference was found withfingertip-to-floor distance and BASMI (P>0.05).Conclusion. Under the normal CRP and ESR circumstances, the prevalence rates ofanxiety and depression in AS patients are higher than it is generally thought. Anxiety anddepression have a considerable effect on pain, BASDAI and BASFI, but have no effects onfingertip-to-floor distance and BASMI. These results highlight that AS patients withnormal CRP and ESR, but continue to rate pain, anxiety and depression should be screenedfor further management. PART Ⅲ Thalidomide in the treatment of patients with active refractory ankylosingspondylitis: the impact on sleep, anxiety, depression and disease parameterBackground and Objective. Thalidomide has sedative, hypnotic and anxiolytic effects. Ithas been used to treat AS by inhibiting synthesis and action of TNF--α. Sleep disorders,anxiety and depression have a closely relationship with elevated levels of TNF-α. Thisstudy was designed to evaluate the effects of thalidomide on sleep, anxiety and depressionin patients with active refractory AS.Metholds. In this6-month case-control study, patients with active refractory AS wererecruited into this study in rheumatology department from July2010to December2011.Thalidomide was used at a dose of150mg/d before sleep. Sleep, psychological andphysical status were assessed at baseline,3month and6month. Blood samples were takento measure CRP, ESR. At the same time, healthy volunteers were selected by age-andgender-matching with AS patients as control group. Results.(1) A total of41patients and30healthy volunteers participated in the study. Sixpatients withdrew from the study because of adverse events, the remaining35patients (31men,5women) with AS completed the clinical trials. Their mean age was32.23±5.74years, and mean disease duration was7.00±4.26years.(2) Sleep disturbances, anxiety anddepression were found in77.1%,57.1%and80%of our patients at baseline. The scores ofPSQI, SAS and SDS were7.20±3.636,51.74±9.35and55.14±9.50respectively.(3) Thelevels of PSQI, SAS, SDS, ESR and CRP in AS patients group were significantly higherthan those in control group at baseline (P>0.05). At the third month, the levels of SDS,SAS and CRP in AS patients group were significantly higher than those in control group(P<0.05), but not PSQI and ESR(P>0.05). At the sixth month, there were not differencebetween AS patients and healthy control groups (P <0.05).(4) All of Clinical parameters,included PSQI, SAS, SDS, BASDAI, BASFI, nocturnal pain, total back pain,fingertip-to-floor distance, duration of morning stiffness, ESR and CRP, significantly lowerlevels of month3and month6were found when compared to initial levels(P <0.05). Therewas no statistically difference in BASMI consistently(P>0.05).(5) The levels of SDS, CRP,BASDAI, nocturnal pain, duration of morning stiffness and fingertip-to-floor distance, atthird month decreased significantly when compared with those of the sixth month(P <0.05),but not PSQI, SAS, ESR, BASFI and total back pain(P>0.05).(6) The percentage of ASpatients with sleep disturbances, depression and anxiety were25.7%,22.9%and28.6%respectively at the end of sixth month.Conclusion. Thalidomide may be effective in the treatment of sleep disturbances, anxietyand depression accompanying refractory AS and it has cumulative effect as durationprolongs...