The Relationship between Self-reported Chronic Pain and Pain related Functional Limitations among Patients with Rheumatoid Arthritis

Objective.To examine the relationship between cognitive impairment and functional limitations and disability in persons with rheumatoid arthritis (RA).Methods.Individuals from a longitudinal cohort study of RA participated in study visits that included physical, psychosocial, and biological metrics. Cognitive function was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices covering a range of cognitive domains. On each test, subjects were classified as “impaired” if they performed 1 SD below age-based population norms. Total cognitive function scores were calculated by summing the number of tests on which individuals were classified as “impaired” (higher scores = greater impairment). Performance-based and self-reported functional limitations were assessed with the Short Physical Performance Battery (SPPB) and the Health Assessment Questionnaire (HAQ), respectively. Self-reported disability was measured with the Valued Life Activities (VLA) scale. Multiple regression analyses controlling for sex, race, education, cardiovascular comorbidity, disease duration, disease severity, and depression were conducted to identify whether cognitive impairment was independently associated with physical function difficulties.Results.There were 122 subjects with mean (SD) age of 58.4 (± 10.8) years; 62% were female and 80% were white. In multivariate regression models, total cognitive function score was significantly associated with greater functional limitations (SPPB: β = −0.24, p = 0.014; HAQ: β = 0.24, p = 0.003) but not with disability (VLA: β = 0.10, p = 0.207).Conclusion.Cognitive impairment was significantly associated with greater functional limitations in patients with RA, suggesting that cognitive impairment may play a role in poor functional status in persons with RA.

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AB0864-HPR INFLUENCE OF THE TYPE OF PAIN SYNDROME ON THE SEVERITY OF ANXIETY-DEPRESSIVE DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2795 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1455.2-1456

Author(s):

E. Egorova ◽

N. Nikitina ◽

A. Rebrov

Keyword(s):

Rheumatoid Arthritis ◽

Severe Pain ◽

Depressive Disorders ◽

Functional Limitations ◽

Joint Damage ◽

Statistical Processing ◽

Pain Syndrome ◽

Anxiety And Depression ◽

Moderate Pain ◽

The Relationship

Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to joint damage and deformation. Pain syndrome, along with functional limitations, causes the emergence of anxiety-depressive disorders. The patient’s psycho-emotional characteristics affect the patient’s quality of life and the effectiveness of the therapy. The aim: to assess the severity of anxiety and depression in women with rheumatoid arthritis, depending on the type of the pain syndrome.Objectives:The study included 163 women with RA according to the EULAR / ACR 2010 criteria (age 53,9 ± 10,15 years, RA duration - 10 [4; 14] years, DAS28 – 5,03 [4,35; 5,8]).Methods:We used the Hospital Depression and Anxiety Scale (HADS) questionnaire: 0-7 points were assessed as the absence of significant symptoms of anxiety and depression, 8-10 points - subclinically expressed anxiety and depression, more than 11 points - clinically expressed anxiety and depression. The severity of pain was determined by the VAS: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), severe pain (75-100 mm). Assessment of the type of pain (identification of the neuropathic component of pain) was carried out using the DN4 questionnaire: a sum of 4 or more points indicated the presence of a neuropathic component of pain (NCP). Statistical processing was performed using the STATISTICA 10,0 program.Results:The frequency of occurrence of anxiety-depressive disorders in RA patients was determined: clinically pronounced anxiety was detected in 35 (21,4%) patients, depression - in 34 (20,9%); subclinically expressed anxiety - in 42 (25,8%), depression - in 44 (27%) patients; absence of reliably pronounced symptoms of anxiety - in 86 (52,8%) patients, depression - in 85 (52,1%) patients.Severe pain according to VAS was noted in 57 (35%) patients, moderate pain - in 75 (46%), in 31 (19%) patients the pain syndrome was mild. In 81 (49,7%) patients a neuropathic component of pain was revealed.The relationship was established between the presence of NCP and the severity of anxiety (r = 0,27, p < 0,05), depression (r = 0,31, p <0,05). The relationship was revealed between the presence of NCP and the severity of pain according to the VAS (r = 0.32, p <0.05).To explain the relationship between the presence of NCP and anxiety-depressive disorders, the patients were divided into two groups depending on the presence of NCP, comparable in age, the main clinical characteristics of RA, and basic therapy. The level of anxiety in women with NCP (9,5 [7; 13]) was significantly higher than in patients without NCP (6.1 [4; 9]) (p = 0.01). The severity of depression in women with NCP was 8,55 [6; 11], in patients without NCP – 5,15 [3; 6] (p = 0.005).Conclusion:Thus, every fifth patient with RA had clinically significance anxiety and depression, subclinical anxiety and depression were found in 26% of RA patients. Most of the patients (81%) had moderate or severe pain, half of the patients had signs of neuropathic pain. The relationship between the severity of anxiety and depression with the intensity of pain and the presence of a neuropathic component was revealed.Disclosure of Interests:None declared

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Functional disability and depression symptoms in a paediatric persistent pain sample

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.05.006 ◽

2017 ◽

Vol 16 (1) ◽

pp. 192-197

Author(s):

Jaclyn Broadbent ◽

Melanie D. Bertino ◽

Leah Brooke ◽

Matthew Fuller-Tyszkiewicz ◽

George Chalkiadis

Keyword(s):

Chronic Pain ◽

Physical Functioning ◽

Daily Living ◽

Functional Disability ◽

Functional Limitations ◽

Depression Symptoms ◽

Symptoms Of Depression ◽

Functional Difficulties ◽

Data Collection Instrument ◽

The Relationship

AbstractBackground and AimsClinicians treating paediatric chronic pain conditions understand that persistent pain, functional ability, and symptoms of depression often co-exist, yet these relationships have only been described to a limited extent by research. This paper more closely examines the relationship between symptoms of depression and subtypes of functional disability.MethodsParticipants included a clinical sample of children and adolescents (N = 239) referred to a paediatric multidisciplinary pain clinic for treatment of persistent or recurrent (chronic) pain in Australia. The majority of participants were female, (76.6%), and were aged 7–17 years (mean age at the time of presentation was 13.8 years). Data from standardized instruments and interview data were collected from a clinical file audit. The Pediatric Outcomes Data Collection Instrument (PODCI) was used as a measure of functional difficulties performing activities of daily living, and the Children’s Depression Inventory (CDI) was used to measure depressive symptoms.ResultsHigh rates of depression and functional disability were observed, but were not associated with one another beyond relatively weak associations. Contrary to prior studies using different measures of physical functioning, depression symptoms were not associated with PODCI functional disability beyond a minor association with anhedonia symptoms (primarily driven by the pain/comfort subscale of the PODCI).Conclusions and ImplicationsWe argue that prior research has measured physical functional limitations in paediatric pain sufferers in a way that is heavily influenced by psychosocial factors, in particular by the symptoms of clinical depression. In contrast, using a measure of physical functioning (PODCI) less influenced by psychosocial factors suggests that the relationship between physical functioning during activities of daily living (e.g., use of upper limbs, basic gross and fine motor skills, basic mobility) and depression is weaker, despite both being heightened in this sample. Unlike other functional disability measures, the Pediatric Outcomes Data Collection Instrument (PODCI) may allow researchers to assess functional limitations somewhat independently of depression symptoms. This conclusion requires replication in further studies, but if confirmed, then the PODCI could be advocated as a useful measure to obtain a more ‘pure’ measure of functional difficulties due to pain, relatively independent of depression.

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Literature Review: Immune System and Its Relation to Depression

Jurnal Psikiatri Surabaya ◽

10.20473/jps.v10i2.28416 ◽

2021 ◽

Vol 10 (2) ◽

pp. 46

Author(s):

Wati Evilia ◽

Anak Ayu Sri Wahyuni ◽

Luh Alit Aryani

Keyword(s):

Rheumatoid Arthritis ◽

Cardiovascular Disease ◽

Chronic Pain ◽

Immune System ◽

Literature Review ◽

Environmental Conditions ◽

Biological Responses ◽

Increase Risk ◽

Maladaptive Response ◽

The Relationship

It has been shown that the immune system and mental status are interrelated. Psychoneuroimmunology is a field that studies these two relationships, one of the most studied is the relationship between the immune system and depression. Psychological stress can substantially increase inflammatory activity and increase risk for various health problems. Socioal-environmental conditions trigger biological responses that may lead to an increase in the proinflammatory phenotype which is hypothesized to be a key phenomenon driving the pathophysiology and relapse of depression, as well as the overlap of depression with several somatic conditions such as rheumatoid arthritis, chronic pain, cardiovascular disease, and neurodegeneration. The immune system and depression have a bidirectional link that influences each other. Exposure to chronic stressful situations can cause a maladaptive response by the immune system, which will be involved in the pathophysiology of depression.

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Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis

Journal of Health Psychology ◽

10.1177/1359105316649785 ◽

2016 ◽

Vol 24 (2) ◽

pp. 153-165 ◽

Cited By ~ 1

Author(s):

Joana Costa ◽

José Pinto-Gouveia ◽

João Marôco

Keyword(s):

Rheumatoid Arthritis ◽

Chronic Pain ◽

Physical Disability ◽

Mediating Effect ◽

Clinical Implications ◽

Pain Experience ◽

The Relationship

The mediating effect of acceptance and mindfulness in the relationship between pain, depression, and physical disability was examined in 55 rheumatoid arthritis patients. Results showed that the relationship between pain and depression was mediated by both nonreact and acceptance. By contrast, the relationship between pain and physical disability was mediated by acceptance but not by nonreact. This study provides evidences that the influence of these processes is different on depression and on physical disability. These findings support models that take both general measures of mindfulness and content-specific measures of acceptance into account when conceptualizing rheumatoid arthritis. Theoretical and clinical implications are discussed.

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The relationship between pain-related fear and hypervigilance in patients with chronic pain

PsycEXTRA Dataset ◽

10.1037/e536932011-113 ◽

2002 ◽

Author(s):

J. Roelofs

Keyword(s):

Chronic Pain ◽

The Relationship

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Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Military Medicine ◽

10.1093/milmed/usaa463 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 502-505

Author(s):

Justin J Stewart ◽

Diane Flynn ◽

Alana D Steffen ◽

Dale Langford ◽

Honor McQuinn ◽

...

Keyword(s):

Chronic Pain ◽

Retrospective Analysis ◽

Extended Period ◽

Pain Clinic ◽

Outcome Variable ◽

Future Research ◽

Curvilinear Relationship ◽

The Impact ◽

Pain Care ◽

The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

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Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Healthcare ◽

10.3390/healthcare9060630 ◽

2021 ◽

Vol 9 (6) ◽

pp. 630

Author(s):

Satoshi Shimo ◽

Yuta Sakamoto ◽

Takashi Amari ◽

Masaaki Chino ◽

Rie Sakamoto ◽

...

Keyword(s):

Chronic Pain ◽

Elderly People ◽

Physical Disability ◽

The Elderly ◽

Daily Basis ◽

Community Dwelling ◽

Negative Effects ◽

The Relationship ◽

Elderly Healthcare ◽

Disability Research

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

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The relationship between sleep and opioids in chronic pain patients

Journal of Behavioral Medicine ◽

10.1007/s10865-021-00205-1 ◽

2021 ◽

Author(s):

Amy Frers ◽

Jonathan Shaffer ◽

Jack Edinger ◽

Amy Wachholtz

Keyword(s):

Chronic Pain ◽

Chronic Pain Patients ◽

The Relationship ◽

Pain Patients

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POS0009 THE RELATIONSHIP BETWEEN DIFFERENT IGG AND IGA ANTI-MODIFIED PROTEIN AUTOANTIBODIES IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3003 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 206.1-207

Author(s):

C. Grönwall ◽

L. Liljefors ◽

H. Bang ◽

A. Hensvold ◽

M. Hansson ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Comprehensive Evaluation ◽

Patient Characteristics ◽

Post Translational Modifications ◽

Cell Clones ◽

Thermo Fisher Scientific ◽

History Of ◽

The Relationship ◽

Fisher Scientific

Background:Seropositive rheumatoid arthritis (RA) is characterized by the presence of rheumatoid factor (RF) and anti-citrullinated protein autoantibodies (ACPA) with different fine-specificities. Yet, other serum anti-modified protein autoantibodies (AMPA), e.g. anti-carbamylated (Carb), anti-acetylated (KAc), and anti-malondialdehyde acetaldehyde (MAA) modified protein antibodies, have been described. By using RA patient single-cell derived monoclonal antibodies we have previously shown that individual ACPA clones recognize small distinct citrulline-containing epitopes giving them extensive multireactivity when these epitopes are found in many peptides and proteins. Moreover, certain CCP2+ multireactive ACPA clones bind also to cabamylated and acetylated autoantigens [1].Objectives:To provide a comprehensive evaluation of serum IgG and IgA autoreactivity to different post-translational modifications in RA.Methods:We analyzed 30 different IgG and IgA AMPA reactivities to modified antigens by ELISA and autoantigen arrays, in N=1985 newly diagnosed RA patients and population controls. The study utilized both previously established (i.e IgG and IgA CCP2; IgG ACPA fine-specificities; IgG anti-Carb fibrinogen and Carb FCS; IgG and IgA Cit/Carb/KAc/Orn(Ac)-vimentin), and novel assays (e.g. IgG anti-MAA and IgG anti-acetylated histones). Association with patient characteristics such as smoking and disease activity were explored. The newly developed assays were also evaluated in SLE disease controls and CCP2+ RA-risk individuals without arthritis.Results:Carb and KAc reactivities by different assays were primarily seen in patients also positive for citrulline-reactivity. Modified vimentin (mod-Vim) peptides were used for direct comparison of different AMPA reactivities, revealing that IgA AMPA recognizing mod-Vim was mainly detected in subsets of patients with high IgG anti-Cit-Vim levels and a history of smoking. IgG acetylation reactivity was mainly detected in a subset of patients with Cit and Carb reactivity. Anti-acetylated histone 2B reactivity was RA-specific and associated with high anti-CCP2 IgG levels, multiple ACPA fine-specificities, and smoking. This reactivity was also found to be present in CCP2+ RA-risk individuals without arthritis. Our data further demonstrate that IgG autoreactivity to MAA was increased in RA compared to controls with highest levels in CCP2+ RA, but was not RA-specific, and showed low correlation with other AMPA. Anti-MAA was instead associated with disease activity and was not significantly increased in CCP2+ individuals at risk of RA. Notably, RA patients could be subdivided into four different subsets based on their AMPA IgG and IgA reactivity profiles.Conclusion:We conclude that autoantibodies exhibiting different patterns of ACPA fine-specificities as well as Carb and KAc reactivity are present in RA and may be derived from multireactive B-cell clones. Anti-Carb and anti-KAc could be considered reactivities within the “Cit-umbrella” similar to ACPA fine-specificities, while MAA is distinctly different.References:[1]Sahlström P, Hansson M, Steen J, Amara K, Titcombe PJ, Forsström B, Stålesen R, Israelsson L, Piccoli L, Lundberg K, Klareskog L, Mueller DL, Catrina AI, Skriner K, Malmström V, Grönwall C. Different Hierarchies of Anti-Modified Protein Autoantibody Reactivities in Rheumatoid Arthritis. Arthritis Rheumatol. 2020 Oct;72(10):1643-1657. PMID: 32501655Caroline Grönwall: None declared, Lisa Liljefors: None declared, Holger Bang Employee of: Employee at ORGENTEC Diagnostika GmbH, Aase Hensvold: None declared, Monika Hansson: None declared, Linda Mathsson-Alm Employee of: Employee at Thermo Fisher Scientific, Lena Israelsson: None declared, Anna Svärd: None declared, Cyril CLAVEL: None declared, Elisabet Svenungsson: None declared, Iva Gunnarsson: None declared, Guy Serre: None declared, Saedis Saevarsdottir: None declared, Alf Kastbom: None declared, Lars Alfredsson: None declared, Vivianne Malmström: None declared, Johan Rönnelid: None declared, Anca Catrina: None declared, Karin Lundberg: None declared, Lars Klareskog: None declared

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