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This single-center study evaluated 68 RA patients by assessing disease severity, fatigue, and sleep quality to test whether fatigue mediates the sleep–severity relationship and whether gender changes these pathways. Results support full mediation, with fatigue significantly carrying the effect from poor sleep to greater severity, while gender did not significantly moderate the mediation route.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/exploring-gender-differences-in-the-impact-of-sleep-and-fatigue-on-disease-severity-in-rheumatoid-arthritis-a-moderated-mediation-model/455266/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/exploring-gender-differences-in-the-impact-of-sleep-and-fatigue-on-disease-severity-in-rheumatoid-arthritis-a-moderated-mediation-model/455266.png","ImageObject",300,407,{"name":92,"@type":93},"jayni","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study’s primary objective?","Question",{"text":112,"@type":113},"To examine whether fatigue mediates the association between sleep quality and disease severity in rheumatoid arthritis, and whether these pathways differ by gender.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was disease severity, fatigue, and sleep quality measured?",{"text":117,"@type":113},"Disease severity was assessed with the Routine Assessment of Patient Index Data-3, fatigue with the Bristol Rheumatology Fatigue Multidimensional Questionnaire, and sleep quality with the Pittsburgh Sleep Quality Index (PSQI).",{"name":119,"@type":110,"acceptedAnswer":120},"What did the results show about mediation and gender moderation?",{"text":121,"@type":113},"Fatigue significantly mediated the relationship between poor sleep quality and disease severity. Gender significantly predicted fatigue and females reported higher fatigue and severity, but gender did not significantly moderate the mediation pathway.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455266,1791318522,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747859343,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Turkish Journal of Medical Sciences  \n\n| Volume 55  Number 6 | Article 22 |\n| --- | --- |\n| 12-12-2025\u003Cbr>Exploring gender differences in the impact of sleep and fatigue on disease severity in rheumatoid arthritis: a moderated mediation model\u003Cbr>MUSA SALMANOĞLU HABİP YILMAZ\u003Cbr>Follow this and additional works at: [https://journals.tubitak.gov.tr/medical](https://journals.tubitak.gov.tr/medical)\u003Cbr> Part of the Medical Sciences Commons |  |\n\nRecommended Citation  \nSALMANOĞLU, M, & YILMAZ, H (2025) . Exploring gender differences in the impact of sleep and fatigue on disease severity in rheumatoid arthritis: a moderated mediation model. Turkish Journal of Medical  \nSciences 55 (6): 1552-1560 . [https://doi.org/10.55730/1300-0144.61](https://doi.org/10.55730/1300-0144.61)13  \nThis work is licensed under a Creative Commons Attribution 4.0 International License.  \nThis Research Article is brought to you for free and open access by TÜBİTAK Academic Journals. It has been accepted for inclusion in Turkish Journal of Medical Sciences by an authorized editor of TÜBİTAK Academic Journals. For more information, please contact [academic.publications@tubitak.gov.tr](academic.publications@tubitak.gov.tr)  \n\n| \u003Cbr>| Turkish Journal of Medical Sciences [http://journals.tubitak.gov.tr/medical/](http://journals.tubitak.gov.tr/medical/)\u003Cbr>\u003Cbr>Research Article | Turk J Med Sci\u003Cbr>(2025) 55: 1552-1560 © TÜBİTAK\u003Cbr>doi:10.55730/1300-0144.6113 |\n| --- | --- | --- |\n\nExploring gender differences in the impact of sleep and fatigue on disease severity in rheumatoid arthritis: a moderated mediation model  \nMusa SALMANOĞLU1,*􀁋, Habip YILMAZ2􀁋  \n1  \nDepartment of Internal Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, Health Sciences University, İstanbul, Turkiye  \n2  \nDepartment of Anesthesiology and Reanimation, Sultan 2. Abdülhamid Han Training and Research Hospital,  \nHealth Sciences University, İstanbul, Turkiye  \nReceived: 17.09.2025  Accepted/Published Online: 01.12.2025  Final Version: 12.12.2025  \nBackground/aim: Rheumatoid arthritis (RA) is often accompanied by fatigue and sleep disturbances, which aggravate disease severity. Gender differences in these interrelationships remain insufficiently understood. This study aimed to examine whether fatigue mediates the association between sleep quality and disease severity in RA, and whether these pathways differ by gender.  \nMaterials and methods: A single-center study was conducted with 68 RA patients (55.9% female). Disease severity was assessed using the Routine Assessment of Patient Index Data-3, fatigue using the Bristol Rheumatology Fatigue Multidimensional Questionnaire, and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) .  \nResults: Fatigue significantly mediated the relationship between poor sleep quality and disease severity (indirect effect β = 0.209, p = 0.003). While gender significantly predicted fatigue (β = 0.297, p = 0.005) and females reported higher fatigue and disease severity, gender did not significantly moderate the mediation pathway (PSQI × gender interaction β = 0.019, p = 0.856). The direct effect of sleep quality on disease severity was not significant (β = 0.047, p = 0.663), supporting a full mediation model. Menopausal status was not significantly related to symptom variation among women with RA.  \nConclusion: Fatigue is a key mechanism connecting poor sleep to greater disease severity in RA. The female participants reported greater symptom burden, underscoring the importance of fatigue-focused, gender-sensitive management strategies.  \nKey words: Rheumatoid arthritis, sleep quality, fatigue, disease severity, gender differences  \n1. Introduction  \nRheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that primarily affects peripheral joints and can lead to irreversible joint destruction, disability, and reduced quality of life [1–5] . Beyond musculoskeletal involvement, RA encompasses a broad spectrum of extraarticular compli","cbCairlL04y6oAxq","https://ap.wps.com/l/cbCairlL04y6oAxq","pdf",484056,"English","# Background/aim\n# Materials and methods\n# Results\n# Conclusion\n# Key words\n# Introduction","[{\"question\":\"What was the study’s primary objective?\",\"answer\":\"To examine whether fatigue mediates the association between sleep quality and disease severity in rheumatoid arthritis, and whether these pathways differ by gender.\"},{\"question\":\"How was disease severity, fatigue, and sleep quality measured?\",\"answer\":\"Disease severity was assessed with the Routine Assessment of Patient Index Data-3, fatigue with the Bristol Rheumatology Fatigue Multidimensional Questionnaire, and sleep quality with the Pittsburgh Sleep Quality Index (PSQI).\"},{\"question\":\"What did the results show about mediation and gender moderation?\",\"answer\":\"Fatigue significantly mediated the relationship between poor sleep quality and disease severity. Gender significantly predicted fatigue and females reported higher fatigue and severity, but gender did not significantly moderate the mediation pathway.\"}]","Exploring gender differences in the impact of sleep and fatigue on disease severity in rheumatoid arthritis: a moderated mediation model | PDF",1790742503,25]