TOPLINE:

A high proportion of patients with rheumatoid arthritis (RA) exhibited sleep impairment. Treatment with upadacitinib improved patient-reported sleep quality at 3 months, with benefits sustained up to 24 months, and actigraphy-based objective sleep quality measures remained unchanged.

METHODOLOGY:

• Researchers in Switzerland conducted the SLEERA study, a substudy of an international observational cohort study, to evaluate the effect of upadacitinib on both subjective (self-reported) and objective (actigraphy-based) sleep quality in patients with RA.
• They included 39 adults with moderate-to-severe active RA (mean age, 59.5 years; 87.2% women; mean disease duration, 7.0 years) who initiated upadacitinib 15 mg once daily. All participants agreed to wear an activity tracker and complete a sleep diary.
• Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire comprising seven components such as sleep quality, sleep duration, sleep latency, and others. Higher scores indicated worse sleep, and a PSQI score > 5 was used for detecting sleep impairment.
• Objective sleep quality was measured using wrist actigraphy, with activity trackers worn on the non-dominant wrist for at least 2 weeks before baseline and before the month 3 visit; sleep periods were detected using the centrepoint algorithm and noted from the sleep diary.
• Primary outcomes were changes in the PSQI total score and actigraphy-based sleep parameters from baseline to month 3 after upadacitinib treatment; the long-term maintenance of improved subjective sleep quality (a PSQI score ≤ 5) was also assessed through months 3, 6, 12, and 24 after treatment initiation.

TAKEAWAY:

• At baseline, 78.4% of patients had impaired sleep. Objective sleep quality was high, with a mean sleep efficiency of 84.2%.
• After 3 months of upadacitinib treatment, the mean total PSQI score changed from baseline by -2.42 points (P < .001), with a significant improvement seen in sleep efficiency, time, and latency (P < .001 for all). Actigraphy across the overall cohort showed no significant change.
• Among 19 patients with impaired sleep quality at baseline, 42.1% achieved good sleep quality at 3 months after treatment, with associated improvements noted in actigraphy-based measures, such as sleep efficiency, total wake time after sleep onset, and movement index. Conversely, 57.9% of those with impaired sleep quality at baseline did not achieve good sleep quality and showed worsened actigraphy-based sleep measurements.
• Only 15.4% of 26 patients had impaired sleep efficiency (< 85%), and it improved after 3 months of treatment with upadacitinib, and these improvements occurred in patients who achieved remission or normalised pain and fatigue. The proportion of patients with good sleep quality (a PSQI score ≤ 5) increased from 21.6% at baseline to 48.5% at month 3, and this improvement was sustained with 47.5% at month 24.

IN PRACTICE:

"[T]his research provides evidence of sleep impairment in RA patients which can be improved with treatment, reinforcing the importance of achieving remission as a key treatment goal. Looking ahead, actigraphy may serve as a valuable tool for monitoring RA patients," the authors wrote.

SOURCE:

This study was led by Thomas Hügle, University Hospital Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland. It was published online on February 27, 2026, in Arthritis Research & Therapy.

LIMITATIONS:

The sample size was small. High interpatient variability and technical limitations of actigraphy may have contributed to the inaccurate estimation of actual sleep activity. A placebo or an active comparator arm was lacking.

DISCLOSURES:

This study was funded by AbbVie. Two authors declared being employees of AbbVie and may hold stock or stock options in the company. Several other authors reported receiving research grants, consulting fees, and/or speaker honoraria from multiple pharmaceutical companies, including AbbVie, AstraZeneca, Janssen, and others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.