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Background: Giant cell arteritis (GCA) is one of the more common forms of large vessel vasculitis occurring in adults older than age 50. It can present with headaches and/or jaw pain, sometimes with flu-like symptoms, fatigue and fever. GCA can impact blood flow to the eye, resulting in visual disturbance or loss. Sleep disorders have rarely been assessed in GCA, even if patients report them.
To evaluate whether the assessment of subjective sleep disorders shows differences at the time of the diagnosis, in the absence of glucocorticoids (GC) therapy, and throughout the GCA disease continuum.
To assess whether the sleep disturbance relate to other disease parameters including other quality of life parameters, functional disability, disease activity, co-morbidities, and glucocorticoids therapy.
Identify the best clinical approach to help GCA patients recover from their illness through the lens of its impact on the patients’ everyday lives.
Methods: This was a cross-sectional observational case-case study. Consecutive GCA patients diagnosed according to the EULAR/ACR criteria and had their diagnosis confirmed by US examination were asked to complete a copy of the GCA-specific Patient Reported Outcome Measures (GCA-PROMs) questionnaire [1]. This includes assessment for quality of life, functional disability, disease symptoms, disease activity parameters, comorbidity, benefit risk ratio of GC and patient’s motivation. Exclusion criteria include history of recent GC therapy and/or of medication to treat sleep disturbance or that could have an impact on the patient’s sleep. After the first visit (T0), GC therapy was commenced following the standard protocols (dose 40-60 mg/day). The baseline parameters were compared to those recorded for the same GCA patients in 1- and 3-months’ time. At 1- and 3-months’ time, all patients were asked to complete another PROMs questionnaire copy. Patients who changed the GCA diagnosis during follow-ups were excluded.
Results: 114 patients were included in this work. At baseline 100% of the patients reported sleeping difficulty, 108/114 (94.7%) reported unable to sleep on the affected side, whereas 6/114 (5.3%) reported sleep with much difficulty. 100% of the patients noted that they had to change their sleep style/position because of the disease. Depression and anxiety were also highly prevalent in the studied cohort with 109 (95.6%) reported either one or both disorders. Sleep disturbance was significantly (p< 0.01) associated with other parameters of quality of life, functional disability score, severity of headache, sensitivity to touch on the affected side, jaw claudication and ESR/CRP level. At 1- and 3-months there was significant improvement of the sleep disturbance (p< 0.001). The improvement in Depression and Anxiety was less significant (p< 0.05) as 74/114 (64.9%) reported improvement in their mood changes but has not reached absent level.
Conclusion: Subjective sleep disorders in GCA patients is a quite common symptom. Patient reported outcomes play a vital role in the baseline assessment and monitoring of the GCA patients. Patient priorities in GCA should be considered amongst the risks and burdens of the disease. According to Borg and Davidson, ‘when it comes to understanding recovery, the trivialities of everyday life must be seen as anything but trivial’ [2].
REFERENCES: [1] El Miedany Y et al. Development of GCA PROMs. Semin Arthritis Rheum 2023; 63:152285.
[2] Borg M, Davidson L. The nature of recovery as lived in everyday experience. J Ment Health 2008; 17:129–40.
Acknowledgements: NIL.
Disclosure of Interests: None declared.