• Abstract 1929: Sleep Impairment Among Adults with Arthritis
• Abstract 1832: Barriers to Exercise Among Adults with Arthritis
• Abstract 1834: Challenges to Promoting Physical Activity in Persons with Arthritis

Abstract 1929: Prevalence and Correlates of Sleep Impairment among Adults with Doctor-Diagnosed Arthritis, United States, 2002
JM Hootman, M Shih, & TJ Brady

Purpose: Data from 31,044 respondents from the 2002 National Health Interview Survey (NHIS) were used to estimate the national prevalence of sleep impairment among adults with self-reported doctor-diagnosed arthritis, and to determine correlates of impaired sleep among this group.

Methods: Those reporting a previous doctors diagnosis of arthritis were classified as having arthritis and sleep impairment was defined as reporting regular insomnia or trouble sleeping in the past 12 months. Variables investigated as correlates of sleep impairment included age, race, sex, education, body mass index, number of chronic conditions, and limitations.

Results: Nearly 21% (42.7 million) of US adults reported doctor-diagnosed arthritis. Of these, 32% (13.8 million) reported sleep impairment compared to 13.5% among adults without arthritis. After statistical adjustment, age > 65 years and body mass index > 30 associated with reduced odds of reporting sleep impairment. Pain, limitations, number of chronic conditions, and anxiety/depression increased the odds of reporting sleep impairment. Self-reported anxiety/depression were the strongest predictors of sleep impairment (odds ratio = 3.8) among arthritis sufferers.

Conclusions: Nearly one-third of adults with doctor-diagnosed arthritis reported sleep impairment. Anxiety and depression were the best predictors of sleep impairment among those with arthritis. Persons with arthritis should be routinely screened for sleep impairment as wells as for psychological distress.

Editorial Comments: Sleep is an important component of general health and quality of life. Sleep may be or particular importance for arthritis sufferers since inadequate sleep associates with chronic pain and fatigue. Because the study is cross-sectional, it is impossible to determine whether the arthritis preceded the sleep impairment. Moreover, it is unclear whether the arthritis, perhaps due to increased pain, promotes sleep impairment or whether psychological distress (also common among arthritis sufferers) leads to sleep impairment. Whatever the case, this study using a large nationally-representative sample, suggests strongly that adults with arthritis are at increased risk of sleep impairment. Regardless of whether this impairment is driven by the arthritis itself, psychological distress or unknown factors it seems clear that addressing sleep impairment should be considered a potential target for intervention among arthritis patients.

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Abstract 1832: Survival Trends in Rheumatoid Arthritis Patients: Is the Mortality Gap Widening?
A Gonzalez, HM Kremers, CS Crowson, KV Ballman, VL Roger, SJ Jacobsen, & SE Gabriel

Purpose: While life expectancy has increased substantially over the past several decades, it is unclear whether RA patients have experienced a similar increase in longevity. This study determined the absolute and relative survival trends in a cohort of RA patients ascertained over a 40-year period.

Methods: A population-based RA incidence cohort (1955-1995) was followed longitudinally until death or January, 2005. Expected mortality rates were estimated using age, sex, and calendar year-specific mortality rates based on the states white population to the person-time experience of the RA cohort. Poisson regression was used to model the observed mortality rates and relative survival after adjusting for age, sex, and disease duration.

Results: This cohort was comprised of 603 RA patients (73% female) with a mean follow-up time of 15 years (with 384 patient deaths). Mortality rate for RA patients over the 40 years of data collection remained constant at 2.1 per 100 person-years. However, the overall expected mortality rate for the general population decreased from 1.7 per 100 person-years in 1965 to 1.1 per 100 person-years in 2000. This indicates a widening mortality gap between RA and general population adults.

Conclusions: RA patients have not enjoyed the same increase in longevity experienced by the general population.

Editorial Comments: The apparent widening mortality gap between RA patients and the general population is of great concern. However, it is important to note that the majority of patients in this cohort were enrolled prior to the recent widespread use of RA disease-modifying agents. As such, it is unknown whether or how these new agents might influence mortality rate. Nonetheless, the results of this analysis underscore the need to better understand the reasons for the increased mortality risk imposed by RA so we can develop treatments to attenuate the RA-associated mortality risks. Cardiovascular disease is thought to be a major contributor to the increased mortality among RA patients and studies are underway to investigate how RA might promote increased risk for cardiovascular disease.

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Abstract 1834: Physical Activity Promotion in Persons with Arthritis: Lessons Learned LS Erlich-Jones, HC Fischer, T Mallinson, P Semanik, J Feinglass, JS Lyon, & RW Chang

Purpose: Exercise can benefit adults with arthritis but adherence is generally low. Thus, strategies need to be developed to promote initiating and sustaining exercise.

Methods: A program of physical activity promotion was developed based on the Coxs Interaction Model of Client Health Behavior. This model helps clients select particular modes of physical activity based on personal and environmental supports that are hypothesized to mediate participation in physical activity.

Results: Trained physical activity advocates helped clients to identify goals, select activities and address potential barriers to becoming more physically active. Challenges were identified with regard to educating clients about the meaning of physical activity terms, using an assessment device that was both convenient and reliable, and developing a numeric scale to rate the degree of change associated with the physical activity. These challenges were addressed by developing an activity log and a monitoring form that captured clients thought and appraisals of their progress, as well as their daily step count.

Conclusions: This pilot study identified and addressed several challenges to promoting physical activity in persons with arthritis. Developing and refining user-friendly methods to help arthritis patients initiate and maintain increased physical activity is essential to assist them to better control their symptoms and, perhaps, slow disease progression.

Editorial Comments: Rheumatologists and allied health professionals are beginning to systematically evaluate approaches to promoting increased physical activity among arthritis patients. This represents a significant advance in that exercise was often thought of as an activity that might exacerbate arthritis and increase its rate of progression. As health professionals from multiple disciplines address this important issue we can look forward to the development and refinement of ever more effective strategies to increase the physical activity of persons with arthritis. This promises not only to improve disease management but enhance the general health of arthritis sufferers as well.

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