Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2014 | Research article

Increased nocturnal periodic limb movements in rheumatoid arthritis patients meeting questionnaire diagnostic criteria for restless legs syndrome

Authors: Regina M Taylor-Gjevre, John A Gjevre, Bindu V Nair

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Abstract

Background

Based on questionnaire criteria, the sensorimotor disorder restless legs syndrome (RLS) has been reported to have a higher prevalence in rheumatoid arthritis (RA) patients than in the general population. There has been some speculation that peripheral arthritic symptoms may allow false positive responses to questionnaire criteria. This study evaluates whether RA patients meeting RLS questionnaire criteria also have objective evidence of increased periodic limb movements (PLMs) characteristic of RLS.

Methods

Participants were recruited from RA clinic. Questionnaire data collected at study entry included: pain scores, rheumatoid arthritis disease activity index, Epworth sleepiness scale, Pittsburgh sleep quality index and RLS diagnostic criteria. Each participant was provided a PAM-RL actigraphic monitor, which attached to the ankle. This device was worn for two consecutive nights then returned for data download. Laboratory data including hemoglobin, iron studies, renal function and C-reactive protein levels were collected.

Results

Of the 57 participants, 23 met RLS diagnostic criteria. Those who met RLS criteria demonstrated higher mean frequency of nocturnal PLMs (19.63/hour; SD:21.13) than those who did not meet RLS criteria (11.13/hour; SD:12.10; p = 0.033). There were no significant differences between groups in terms of patient characteristics, disease activity or duration measures. Patients meeting RLS criteria did have poorer sleep quality measures (p <0.001).

Conclusions

RA patients who met RLS diagnostic criteria demonstrated higher frequencies of nocturnal PLMs than RA patients who did not meet criteria for RLS. This finding supports use of the RLS diagnostic criteria in helping to differentiate between RA arthritic symptoms and RLS.

Available only for authorised users

Reynolds G, Blake DR, Pall HS, Williams A: Restless leg syndrome and rheumatoid arthritis. BMJ. 1986, 292: 659-660. 10.1136/bmj.292.6521.659.CrossRefPubMedPubMedCentral

Salih AM, Gray RE, Mills KR, Webley M: A clinical, serological and neurophysiological study of restless legs syndrome in rheumatoid arthritis. Br J Rheumatol. 1994, 33: 60-63. 10.1093/rheumatology/33.1.60.CrossRefPubMed

Allen RP, Picchietti D, Hening A, Trenkwalder C, Walters AS, Montplaisi J, Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003, 4: 101-119. 10.1016/S1389-9457(03)00010-8.CrossRefPubMed

Taylor-Gjevre RM, Gjevre JA, Skomro R, Nair B: Restless legs syndrome in a rheumatoid arthritis patient cohort. J Clin Rheumatol. 2009, 15: 12-15. 10.1097/RHU.0b013e318190f94c.CrossRefPubMed

Taylor-Gjevre RM, Gjevre JA, Nair B, Skomro R, Lim HJ: Hypersomnolence and sleep disorders in a rheumatic disease patient population. J Clin Rheumatol. 2010, 16: 255-261. 10.1097/RHU.0b013e3181eeb2df.CrossRefPubMed

Hening WA, Allen RP, Washburn M, Lesage SR, Earley CJ: The four diagnostic criteria for restless legs syndrome are unable to exclude confounding conditions (“mimics”). Sleep Med. 2009, 10: 976-981. 10.1016/j.sleep.2008.09.015.CrossRefPubMedPubMedCentral

Cippa MAT, Baumann CR, Siccoli MM, Bassetti CL, Poryazova R, Werth E: Actigraphic assessment of periodic leg movements in patients with restless legs syndrome. J Sleep Res. 2013, 22: 589-592. 10.1111/jsr.12053.CrossRefPubMed

Fransen J, Langenegger T, Michel BA, Stucki G: Feasibility and validity of the RADAI, a self-administered rheumatoid arthritis disease activity index. Rheumatology. 2000, 39: 321-327. 10.1093/rheumatology/39.3.321.CrossRefPubMed

Buysse DJ, Reynolds CFI, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989, 28: 193-213. 10.1016/0165-1781(89)90047-4.CrossRefPubMed

10.

Johns MJ: A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991, 14: 540-545.PubMed

11.

Sforza E, Johannes M, Claudio B: The PAM-RL ambulatory device for detection of periodic leg movements: a validation study. Sleep Med. 2005, 6: 407-413. 10.1016/j.sleep.2005.01.004.CrossRefPubMed

12.

Campbell MJ, Julious SA, Altman DG: Estimating sample sizes for binary, ordered categorical and continuous outcomes in two group comparisons. BMJ. 1995, 311: 1145-1148. 10.1136/bmj.311.7013.1145.CrossRefPubMedPubMedCentral

13.

Kobayashi M, Namba K, Ito E, Nishida M, Ueki Y, Furudate N, Kagimura T, Usui A, Inoue Y: The validity of the PAM-RL device for evaluating periodic limb movements in sleep and an investigation on night to night variability of periodic limb movements during sleep in patients with restless legs syndrome or periodic limb movement disorder using this system. Sleep Med. 2014, 15: 138-143. 10.1016/j.sleep.2013.08.790.CrossRefPubMed

14.

Gschliessser V, Frauscher B, Brandauer E, Kohnen R, Ulmer H, Poewe W, Hogl B: PLM detection by actigraphy compared to polysomnography: a validation and comparison of two actigraphs. Sleep Med. 2009, 10: 306-311. 10.1016/j.sleep.2008.03.015.CrossRef

15.

Gjevre JA, Taylor-Gjevre RM, Nair BV, Lim HJ: Do sleepy rheumatoid arthritis patients have a sleep disorder?. Musculoskeletal Care. 2012, 10: 187-195. 10.1002/msc.1016.CrossRefPubMed

16.

Gjevre JA, Taylor-Gjevre RM: Restless legs syndrome as a comorbidity in rheumatoid arthritis. Autoimmune Dis. 2013, Article ID 352782. doi:10.1155/2013/352782

17.

Taylor-Gjevre RM, Gjevre JA, Skomro R, Nair BV: Assessment of sleep health in patients with rheumatic disease. Int J Clin Rheumatol. 2011, 6: 207-218. 10.2217/ijr.11.6.CrossRef

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/15/378/prepub

Title: Increased nocturnal periodic limb movements in rheumatoid arthritis patients meeting questionnaire diagnostic criteria for restless legs syndrome
Authors: Regina M Taylor-Gjevre
John A Gjevre
Bindu V Nair
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-15-378

At a glance: The STEP trials

Springer Medicine

Increased nocturnal periodic limb movements in rheumatoid arthritis patients meeting questionnaire diagnostic criteria for restless legs syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

The discriminative ability of FRAX, the WHO algorithm, to identify women with prevalent asymptomatic vertebral fractures: a cross-sectional study

Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment

Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain: a complier average causal effect approach to the BeST data set

Evaluation of self-administered tests for pelvic girdle pain in pregnancy

Osteogenic differentiation of amniotic epithelial cells: synergism of pulsed electromagnetic field and biochemical stimuli