Sleep Disturbance Predicts Future Pain Interference in Early Rheumatoid Arthritis, Study Finds

New data from a prospective observational study of patients with early rheumatoid arthritis (RA) show that sleep disturbance significantly predicts how much pain will interfere with daily functioning over time. The findings highlight the clinical importance of evaluating and managing sleep issues early in the disease course.

The study analyzed data from 502 adults enrolled in the Canadian Early Arthritis Cohort between 2016 and 2023. All patients had joint symptoms for less than 12 months at baseline. Participants completed standardized clinical assessments and patient-reported outcomes using the PROMIS (Patient-Reported Outcomes Measurement Information System) framework at five time points: baseline, 6, 12, 18, and 24 months.

Sleep disturbance was the primary predictor, and pain interference was the primary outcome. To assess the directional relationship between these variables, the study used a lagged analysis design. Sleep scores at baseline and subsequent follow-ups were used to predict pain interference six months later. Researchers applied linear mixed-effects models to estimate both unadjusted and adjusted associations, controlling for factors including age, sex, BMI, education, income, smoking status, comorbidities, disease activity, treatment, and depression.

The results demonstrated a significant longitudinal association: patients reporting greater sleep disturbance at one time point were more likely to report higher pain interference six months later.

“The unadjusted and adjusted linear mixed-effects models revealed a significant association between sleep disturbance and subsequent pain interference scores,” the authors reported, “indicating that worse sleep six months prior was associated with greater pain interference at the following six-month evaluation.”

This relationship persisted even after controlling for key demographic, clinical, and psychosocial variables, suggesting that sleep disruption is an independent predictor of future pain-related functional limitations in early RA.

At baseline, the mean disease duration in the cohort was 5.4 months (SD 2.9), with a mean age of 56 years. The sample was 68% female and 81% White. This population profile reflects a typical early RA demographic and supports generalizability to early patients with RA seen in routine clinical practice.

The study’s lagged design is a critical strength, establishing a temporal sequence in which sleep disturbance precedes and predicts subsequent pain interference. While prior research has documented cross-sectional associations between poor sleep and pain, this analysis adds important prospective evidence specific to early RA.

The authors conclude, “These findings underscore the importance of addressing sleep disturbances as part of pain management strategies soon after RA diagnosis.”

For practicing rheumatologists, the key takeaway is clear: identifying and managing sleep disturbances early may represent a modifiable factor in reducing future pain-related disability. Incorporating sleep screening into early RA evaluations and considering referral for behavioral or pharmacologic interventions when needed could improve long-term patient outcomes.

The study supports an integrated approach to early RA care—one that considers not only inflammation and structural joint damage, but also biopsychosocial contributors to pain and functioning.

Reference
Aydemir B, Schieir O, Valois MF, et al. Association between sleep disturbance and subsequent pain interference in patients with early rheumatoid arthritis. Arthritis Care Res (Hoboken). Published online May 12, 2025. doi:10.1002/acr.25568