Abstract
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.
Similar content being viewed by others
Availability of data and materials
The data underlying this article will be shared on reasonable request to the corresponding author and following ethical or other needed approval.
References
Michelsen B, Uhlig T, Sexton J et al (2018) Health-related quality of life in patients with psoriatic and rheumatoid arthritis: data from the prospective multicentre NOR-DMARD study compared with Norwegian general population controls. Ann Rheum Dis 77:1290–1294. https://doi.org/10.1136/annrheumdis-2018-213286
Rohde G, Berg KH, Proven A, Haugeberg G (2017) The relationship between demographic- and disease-related variables and health-related quality of life in patients with axial spondyloarthritis. BMC Musculoskelet Disord 18:328. https://doi.org/10.1186/s12891-017-1693-z
Strand V, Sharp V, Koenig AS et al (2012) Comparison of health-related quality of life in rheumatoid arthritis, psoriatic arthritis and psoriasis and effects of etanercept treatment. Ann Rheum Dis 71:1143–1150. https://doi.org/10.1136/annrheumdis-2011-200387
Salaffi F, Carotti M, Gasparini S et al (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25. https://doi.org/10.1186/1477-7525-7-25
Salaffi F, Di Carlo M, Carotti M et al (2019) The impact of different rheumatic diseases on health-related quality of life: a comparison with a selected sample of healthy individuals using SF-36 questionnaire, EQ-5D and SF-6D utility values. Acta Biomed 89:541–557
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 Corrona Registries. Rheumatol Ther 6:529–542. https://doi.org/10.1007/s40744-019-00172-9
Orbai AM, de Wit M, Mease P et al (2017) International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis 76:673–680. https://doi.org/10.1136/annrheumdis-2016-210242
Heiberg T, Kvien TK (2002) Preferences for improved health examined in 1,024 patients with rheumatoid arthritis: pain has highest priority. Arthritis Rheum 47:391–397. https://doi.org/10.1002/art.10515
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 70:703–712. https://doi.org/10.1002/acr.23339
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
Michelsen B, Kristianslund EK, Hammer HB et al (2017) Discordance between tender and swollen joint count as well as patient’s and evaluator’s global assessment may reduce likelihood of remission in patients with rheumatoid arthritis and psoriatic arthritis: data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis 76:708–711. https://doi.org/10.1136/annrheumdis-2016-210283
Lampa J (2019) Pain without inflammation in rheumatic diseases. Best Pract Res Clin Rheumatol 33:101439. https://doi.org/10.1016/j.berh.2019.101439
Larice S, Ghiggia A, Di Tella M et al (2020) Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scand J Psychol 6:271–280. https://doi.org/10.1111/sjop.12592
Petrini L, Arendt-Nielsen L (2020) Understanding pain catastrophizing: putting pieces together. Front Psychol 11:603420. https://doi.org/10.3389/fpsyg.2020.603420
Peters ML (2015) Emotional and cognitive influences on pain experience. Mod Trends Pharmacopsychiatry 30:138–152. https://doi.org/10.1159/000435938
Edwards RR, Cahalan C, Mensing G et al (2011) Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 7:216–224. https://doi.org/10.1038/nrrheum.2011.2
Gracely RH, Geisser ME, Giesecke T et al (2004) Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain 127:835–843. https://doi.org/10.1093/brain/awh098
Edwards RR, Kronfli T, Haythornthwaite JA et al (2008) Association of catastrophizing with interleukin-6 responses to acute pain. Pain 140:135–144. https://doi.org/10.1016/j.pain.2008.07.024
Schweinhardt P, Kalk N, Wartolowska K et al (2008) Investigation into the neural correlates of emotional augmentation of clinical pain. Neuroimage 40:759–766. https://doi.org/10.1016/j.neuroimage.2007.12.016
George SZ, Wallace MR, Wright TW et al (2008) Evidence for a biopsychosocial influence on shoulder pain: pain catastrophizing and catechol-O-methyltransferase (COMT) diplotype predict clinical pain ratings. Pain 136:53–61. https://doi.org/10.1016/j.pain.2007.06.019
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
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
Rudwaleit M, van der Heijde D, Landewe 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
Hays RD, Morales LS (2001) The RAND-36 measure of health-related quality of life. Ann Med 33:350–357. https://doi.org/10.3109/07853890109002089
Lee A, Browne MO, Villanueva E (2008) Consequences of using SF-12 and RAND-12 when examining levels of well-being and psychological distress. Aust N Z J Psychiatry 42:315–323. https://doi.org/10.1080/00048670701881579
Jensen MP, Keefe FJ, Lefebvre JC et al (2003) One- and two-item measures of pain beliefs and coping strategies. Pain 104:453–469. https://doi.org/10.1016/s0304-3959(03)00076-9
Steyberg E (2009) Clinical prediction models. A practical approach to development, validation, and updating. Springer
Hair JF, Black WC, Babin BJ, Anderson RE (2010) Multivariate data analysis: international version. Pearson, New Jersey
Dagfinrud H, Mengshoel AM, Hagen KB et al (2004) Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis 63:1605–1610. https://doi.org/10.1136/ard.2003.019224
Adams RJ (2010) Improving health outcomes with better patient understanding and education. Risk Manag Healthc Policy 3:61–72. https://doi.org/10.2147/rmhp.s7500
Navarro-Abal Y, Climent-Rodriguez JA, Lopez-Lopez MJ, Gomez-Salgado J (2018) Psychological coping with job loss Empirical study to contribute to the development of unemployed people. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph15081787
Sansone RA, Watts DA, Wiederman MW (2014) Pain catastrophizing and employment histories. Occup Med (Lond) 64:294–296. https://doi.org/10.1093/occmed/kqu023
Chorus AM, Miedema HS, Boonen A, Van Der Linden S (2003) Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 62:1178–1184. https://doi.org/10.1136/ard.2002.004861
Nagy G, Roodenrijs NMT, Welsing PM 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
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
Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44. https://doi.org/10.1016/0304-3959(83)90125-2
Yoshida T, Hashimoto M, Horiguchi G et al (2021) Pain catastrophizing hinders Disease Activity Score 28 - erythrocyte sedimentation rate remission of rheumatoid arthritis in patients with normal C-reactive protein levels. Int J Rheum Dis 24:1520–1529. https://doi.org/10.1111/1756-185x.14231
Cohen EM, Edwards RR, Bingham CO et al (2019) Pain and catastrophizing in patients with rheumatoid arthritis: an observational cohort study. J Clin Rheumatol 25:232–236. https://doi.org/10.1097/rhu.0000000000000834
Haugeberg G, Hansen I, Hammer H et al (2020) THU0482 Pain catastrophizing and disease perception differs between Norwegian and Finnish outpatient clinic psoriatic arthritis patients despite comparable outcomes on objective measures of disease. Ann Rheum Dis 79(478):1–9. https://doi.org/10.1136/annrheumdis-2020-eular.1635
Acknowledgements
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.
Author information
Authors and Affiliations
Contributions
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.
Corresponding author
Ethics declarations
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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). https://doi.org/10.1007/s00296-021-05070-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-021-05070-4