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Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders

  • Observational Research
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Abstract

Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient’s personality traits and coping abilities, plays a less important role for the patient than general pain perception.

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References

  1. Mease PJ, Liu M, Rebello S et al (2019) Comparative disease burden in patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis: data from two corona registries. Rheumatol Ther 6:529–542. https://doi.org/10.1007/S40744-019-00172-9/FIGURES/2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hsieh PH, Wu O, Geue C et al (2020) Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era. Ann Rheum Dis 79:771–777. https://doi.org/10.1136/ANNRHEUMDIS-2019-216243

    Article  PubMed  Google Scholar 

  3. Krüger K, Burmester GR, Wassenberg S et al (2019) Patient-reported outcomes with golimumab in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: non-interventional study GO-NICE in Germany. Rheumatol Int 39:131–140. https://doi.org/10.1007/S00296-018-4180-4/FIGURES/6

    Article  PubMed  Google Scholar 

  4. Pilgaard T, Hagelund L, Stallknecht SE et al (2019) Severity of fatigue in people with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis - results of a cross-sectional study. PLoS ONE 14:e021883. https://doi.org/10.1371/JOURNAL.PONE.0218831

    Article  Google Scholar 

  5. Kerola AM, Kazemi A, Rollefstad S et al (2022) All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology (Oxford) 61:4656–4666. https://doi.org/10.1093/RHEUMATOLOGY/KEAC210

    Article  PubMed  Google Scholar 

  6. Chimenti MS, D’antonio A, Conigliaro P et al (2020) An update for the clinician on biologics for the treatment of psoriatic arthritis. Biologics 14:53–75. https://doi.org/10.2147/BTT.S260754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Janke K, Biester K, Krause D et al (2020) Comparative effectiveness of biological medicines in rheumatoid arthritis: systematic review and network meta-analysis including aggregate results from reanalysed individual patient data. BMJ 370:m2288. https://doi.org/10.1136/BMJ.M2288

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ho A, Younis I, Le QA (2022) Impact of biologics on health-related quality of life in patients with ankylosing spondylitis: a systematic review and meta-analysis of randomized controlled trials. Semin Arthritis Rheum 54:151996. https://doi.org/10.1016/J.SEMARTHRIT.2022.151996

    Article  CAS  PubMed  Google Scholar 

  9. Roodenrijs NMT, van der Goes MC, Welsing PMJ et al (2021) Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology 60:3778–3788. https://doi.org/10.1093/RHEUMATOLOGY/KEAA860

    Article  PubMed  Google Scholar 

  10. Garrido-Cumbrera M, Hillmann O, Mahapatra R et al (2017) Improving the management of psoriatic arthritis and axial spondyloarthritis: roundtable discussions with healthcare professionals and patients. Rheumatol Ther 4:219. https://doi.org/10.1007/S40744-017-0066-2

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vergne-Salle P, Pouplin S, Trouvin AP et al (2020) The burden of pain in rheumatoid arthritis: Impact of disease activity and psychological factors. Eur J Pain 24:1979. https://doi.org/10.1002/EJP.1651

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bar-Shalita T, Cermak SA (2020) Multi-sensory responsiveness and personality traits predict daily pain sensitivity. Front Integr Neurosci 13:77. https://doi.org/10.3389/FNINT.2019.00077/BIBTEX

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bruce TO (2008) Comorbid depression in rheumatoid arthritis: pathophysiology and clinical implications. Curr Psychiatry Rep 10:258–264. https://doi.org/10.1007/S11920-008-0042-1

    Article  PubMed  Google Scholar 

  14. Sturgeon JA, Finan PH, Zautra AJ (2016) Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol 12:532. https://doi.org/10.1038/NRRHEUM.2016.112

    Article  PubMed  PubMed Central  Google Scholar 

  15. Leung L (2012) Pain catastrophizing: an updated review. Indian J Psychol Med 34:204–217. https://doi.org/10.4103/0253-7176.106012

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hammer HB, Uhlig T, Kvien TK, Lampa J (2018) Pain catastrophizing, subjective outcomes, and inflammatory assessments including ultrasound: results from a longitudinal study of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 70:703–712. https://doi.org/10.1002/ACR.23339

    Article  PubMed  Google Scholar 

  17. Zhaoyang R, Martire LM, Darnall BD (2020) Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis. Pain 161:2603–2610. https://doi.org/10.1097/J.PAIN.0000000000001959

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shim EJ, Hahm BJ, Go DJ et al (2018) Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disabil Rehabil 40:1509–1516. https://doi.org/10.1080/09638288.2017.1300691

    Article  PubMed  Google Scholar 

  19. Galvez-Sánchez CM, Montoro CI, Duschek S, del Paso GAR (2020) Pain catastrophizing mediates the negative influence of pain and trait-anxiety on health-related quality of life in fibromyalgia. Qual Life Res 29:1871–1881. https://doi.org/10.1007/S11136-020-02457-X

    Article  PubMed  Google Scholar 

  20. Weissman-Fogel I, Sprecher E, Pud D (2008) Effects of catastrophizing on pain perception and pain modulation. Exp Brain Res 186:79–85. https://doi.org/10.1007/S00221-007-1206-7

    Article  PubMed  Google Scholar 

  21. Toledo TA, Kuhn BL, Payne MF et al (2020) The effect of pain catastrophizing on endogenous inhibition of pain and spinal nociception in Native Americans: results from the Oklahoma study of Native American pain risk. Ann Behav Med 54:575–594. https://doi.org/10.1093/ABM/KAAA004

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ferdek MA, Adamczyk AK, van Rijn CM et al (2019) Pain catastrophizing is associated with altered EEG effective connectivity during pain-related mental imagery. Acta Neurobiol Exp (Wars) 79:53–72. https://doi.org/10.21307/ane-2019-005

    Article  PubMed  Google Scholar 

  23. Ellingson LD, Stegner AJ, Schwabacher IJ et al (2018) Catastrophizing interferes with cognitive modulation of pain in women with fibromyalgia. Pain Med 19:2408–2422. https://doi.org/10.1093/PM/PNY008

    Article  PubMed  PubMed Central  Google Scholar 

  24. Michelsen B, Kristianslund EK, Sexton J et al (2017) Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis 76:1906–1910. https://doi.org/10.1136/ANNRHEUMDIS-2017-211284

    Article  PubMed  Google Scholar 

  25. Wilk M, Łosińska K, Pripp AH et al (2022) Pain catastrophizing in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: biopsychosocial perspective and impact on health-related quality of life. Rheumatol Int 42:669–682. https://doi.org/10.1007/S00296-021-05070-4

    Article  PubMed  Google Scholar 

  26. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588. https://doi.org/10.1136/ARD.2010.138461

    Article  PubMed  Google Scholar 

  27. Taylor W, Gladman D, Helliwell P et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673. https://doi.org/10.1002/ART.21972

    Article  PubMed  Google Scholar 

  28. Rudwaleit M, van der Heijde D, Landewé R et al (2009) The development of assessment of spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783. https://doi.org/10.1136/ARD.2009.108233

    Article  CAS  PubMed  Google Scholar 

  29. de Lusignan S, Crawford L, Munro N (2015) Creating and using real-world evidence to answer questions about clinical effectiveness. BMJ Health Care Inform 22:368–373. https://doi.org/10.14236/JHI.V22I3.177

    Article  Google Scholar 

  30. Hair JF et al (2010) Multivariate data analysis: international version. Pearson, New Jersey

    Google Scholar 

  31. Brkic A, Łosińska K, Pripp AH et al (2022) Remission or not remission, that’s the question: shedding light on remission and the impact of objective and subjective measures reflecting disease activity in rheumatoid arthritis. Rheumatol Ther 2022:1–17. https://doi.org/10.1007/S40744-022-00490-5

    Article  Google Scholar 

  32. Paulshus Sundlisæter N, Sundin U, Aga AB et al (2022) Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study. RMD Open 8:e002013. https://doi.org/10.1136/RMDOPEN-2021-002013

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nowell WB, Gavigan K, Kannowski CL et al (2021) Which patient-reported outcomes do rheumatology patients find important to track digitally? A real-world longitudinal study in ArthritisPower. Arthritis Res Ther 23:53. https://doi.org/10.1186/S13075-021-02430-0

    Article  PubMed  PubMed Central  Google Scholar 

  34. Meisingset I, Vasseljen O, Vøllestad NK et al (2020) Novel approach towards musculoskeletal phenotypes. Eur J Pain 24:921–932. https://doi.org/10.1002/EJP.1541

    Article  PubMed  Google Scholar 

  35. Nagy G, Roodenrijs NMT, Welsing PMJ et al (2021) EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 80:31–35. https://doi.org/10.1136/ANNRHEUMDIS-2020-217344

    Article  PubMed  Google Scholar 

  36. Buch MH, Eyre S, McGonagle D (2021) Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nat Rev Rheumatol 17:17–33. https://doi.org/10.1038/S41584-020-00541-7

    Article  PubMed  Google Scholar 

  37. Diab R, Bomar R, Slaven J et al (2022) Nurse-supported web-based cognitive behavioral therapy for chronic musculoskeletal pain: a randomized controlled trial. Pain Physician 25:E959–E968

    PubMed  Google Scholar 

  38. Park SJ, Yoon DM, Yoon KB et al (2016) Factors associated with higher reported pain levels in patients with chronic musculoskeletal pain: a cross-sectional, correlational analysis. PLoS ONE 11:e0163132. https://doi.org/10.1371/JOURNAL.PONE.0163132

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sharma S, Ferreira-Valente A, Williams ACDC et al (2020) Group differences between countries and between languages in pain-related beliefs, coping, and catastrophizing in chronic pain: a systematic review. Pain Med 21:1847–1862. https://doi.org/10.1093/PM/PNZ373

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Preliminary results of this study were reported at Annual European Congress of Rheumatology EULAR 2021 as oral abstract presentation in “The origins of pain in RMDs” session (02 June 2021) (http://dx.doi.org/10.1136/annrheumdis-2021-eular.3715). Manuscript proofreading was performed by Proof-Reading-Service.com Ltd, Devonshire Business Centre, Works Road, Letchworth Garden City, Hertfordshire, SG6 1GJ, United Kingdom.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

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Authors and Affiliations

  1. Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland

    Mateusz Wilk & Mariusz Korkosz

  2. Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway

    Are H. Pripp

  3. Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland

    Mariusz Korkosz

  4. Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway

    Glenn Haugeberg

  5. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Glenn Haugeberg

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  1. Mateusz Wilk
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  4. Glenn Haugeberg
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Contributions

MW, AHP, MK, GH: conceptualization, study design; GH: patients enrolment, data acquisition; MW, AHP, MK, GH: data analysis and interpretation; MW, AHP: statistical analyses; MW: drafting manuscript; AHP, MK, GH: revision of the manuscript. All authors have read and approved the final submitted version of the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Mateusz Wilk.

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Conflict of interest

Mateusz Wilk: none declared; Are Hugo Pripp: none declared; Mariusz Korkosz: none declared; Glenn Haugeberg: Previous founder and shareholder in the company DiaGraphIT AS; manufacturing the GoTreatIT Rheuma computer tool used to collect data in this study.

Ethical approval

The approval for this study was given by the regional ethical committee (Regional etisk komite Midt-Norge 2010/3078) to analyse anonymised data from outpatient clinics in Norway. No consent from patients was needed according to the ethical committee, as all the data described above were collected as part of clinical care to facilitate treatment decisions.

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Wilk, M., Pripp, A.H., Korkosz, M. et al. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 43, 687–694 (2023). https://doi.org/10.1007/s00296-023-05271-z

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  • DOI: https://doi.org/10.1007/s00296-023-05271-z

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