Sleep and rheumatic disease.

Patients with rheumatic diseases often exhibit sleep disturbance. Identification of primary sleep disorders; medical, neurologic, and psychologic illnesses; circadian factors; and the use and effect of medications, drugs, and alcohol will provide a strong basis for pursuing both pharmacologic and nonpharmacologic intervention. Recent clinical research confirms the frequent comorbidity of sleep disturbance, pain, fatigue, stress, and mood disturbance in patients with rheumatic disease. It is essential for effective management to recognize these "symptom syndromes" that are often responsive to treatment (suggesting a common biologic action and effect of the drugs used) despite a continuing presence of underlying chronic disease. The pathophysiologic relationships of these comorbid symptoms are mostly unknown, so this is an area for further study.