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Pain catastrophizing in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: biopsychosocial perspective and impact on health-related quality of life


Pain catastrophizing (PC), defined as tendency to describe pain in more exaggerated terms, to ruminate more or to feel helpless about it. Main objective was to illuminate PC in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), revealing its prevalence and associations from a biopsychosocial perspective, including its association with health-related quality of life (HRQoL). Measures reflecting the biological, social and psychological perspective were recorded in RA, PsA and axSpA outpatients. Biological variables including demographics, disease activity and patient reported outcomes (PROs) along with variables reflecting psychological and social domains were collected. RAND12 questionnaire was used to explore HRQoL and standardized questionnaire was used to reveal pain catastrophizing score (PCS). 1229 patients were recruited (RA 580, PsA 394, axSpA 255). Mean (SD) PCS were for RA 1.88 (1.39), PsA 2.06 (1.45) and axSpA 2.27 (1.37). Proportion of pain catastrophizers (score ≥ 4) was not statistically different between RA (10.5%), PsA (12.7%) and axSpA (15.3%). Across all diagnoses, variables reflecting biological subjective domain explained more PCS variability (adjusted R2 35.3–49.9%) than psychological (28.4–33.6%), social (22.4–28.4%) and biological objective (4.3–9.9%) domains. HRQoL was significantly lower in pain catastrophizers across all diagnoses. No substantial differences in proportion of pain catastrophizers between RA, PsA and axSpA patients were found. Higher PCS (score ≥ 4) was best explained by biological subjective measures and corresponded with inferior HRQoL in all diseases. Several biological objectives, psychological and social measures were also associated with higher PCS.

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Authors and Affiliations



MW, KŁ, AHP, MK, GH: conceptualization, study design; GH: study advertisement, data acquisition; MW, KŁ, AHP, MK, GH: data analysis and interpretation; MW, AHP: statistical analyses; MW, KŁ, AHP, MK, GH: redaction of the manuscript. All authors have read and approved the final submitted version of the manuscript.

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Correspondence to Mateusz Wilk.

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Conflict of interest

Mateusz Wilk: none declared. Katarzyna Łosińska: none declared. Are Hugo Pripp: none declared. Mariusz Korkosz: none declared. Glenn Haugeberg was 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 was given by the regional ethical committee (Regional etisk komite Midt-Norge 2010/3078) to analyze anonymized data. 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., Łosińska, K., Pripp, A.H. et al. 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 (2022).

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  • Inflammatory diseases
  • Pain
  • Pain catastrophizing
  • Quality of life