AB0713 PAIN CATASTROPHIZING AND ITS DOMAINS HELPLESSNESS AND RUMINATION IMPACT SIGNIFICANTLY ON DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: DATA FROM A MULTICENTER ITALIAN STUDY
Authors: L. Kun, D. Currado, O. Berardicurti, M. Vomero, A. Marino, A. Biaggi, A. Pilato, E. Corberi, F. Trunfio, A. Orlando, M. Quadrini, F. Saracino, L. Lamberti, L. Navarini, R. Giacomelli
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In rheumatic diseases, increasing emphasis is put on the role of psychosocial factors in the experience of pain. Among these factors, pain catastrophizing (PC), an inclination to exaggerate in describing pain, to ruminate, or to feel helplessness about it, has emerged. While associated with subjective perception, PC doesn't align with inflammation biomarkers. The mechanisms underlying these effects remain not fully elucidated, positioning PC as a key variable that might shed light on why certain patients struggle to achieve treatment targets. Many studies demonstrate impact of Rheumatoid Arthritis (RA) on physical, psychological, and social aspects, impairing quality of life. In RA patients, PC is more prevalent than in the general population, impacting drug retention. <h3>Objectives:</h3> We aimed to evaluate PC and its related domains (Rumination, Magnification, and Helplessness) in RA patients and assess its impact on disease activity in models adjusted for different psychometric domains, such as anxious and depressive symptoms. <h3>Methods:</h3> We conducted a multi-center, cross-sectional, observational study on consecutive RA patients fulfilling ACR/EULAR criteria. Comorbidities and antibody status were collected at enrolment. Disease activity has been assessed with composite indices, such as Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI). For assessment of physical, psychological, and social status validated questionnaires have been administered: Health Assessment Questionnaire, Hospital Anxiety and Depression Scale, Trait Hope Scale and its domain Agency and Pathway, Acceptance and Action Questionnaire and Compassionate Engagement and Action Scales. Furthermore, PC has been assessed using the Pain Catastrophising Scale (PCS), characterized by 3 domains: rumination, magnification and helplessness. Univariate and multivariable regressions were performed to evaluate possible predictors of disease activity, including PC and its domains. All the statistical analysis has been performed using Stata v. 14 (College Station, Texas, USA) <h3>Results:</h3> We enrolled 158 RA patients (age 61 (51-69) years, males/females 29.11/70.9%). In this subset, we observed that the median CDAI value was 8.05 (2-14.5) and SDAI 8.14 (2.26-14.7). Concomitant fibromyalgia was present in 17.97% and lung involvement (LI) in 6.8% of participants. The analysis of the PCS showed a median value of 17 (8-26) and its specific domains showed helplessness 6 (2-11), Rumination 7 (3-11), Magnification 2 (1-4). The main demographic, anthropometric, and clinical characteristics of the study population are reported in Table 1. Using the cut-off point marking the difference of clinically significant from non-significant PC (PCS=30), patients with PCS &gt;30 showed a positive association with the values of tender joints (p=0.0007), swollen joints (p=0.0336), VAS pain (p=0.0086), patients' global assessment (p=0.0002), physician global assessment (p=0.0129), CDAI (p&lt;0.0001), SDAI (p=0.0001) and LI (p=0.013). Univariable and multivariable regression considering SDAI as a dependent variable are summarized in Table 2. In multivariable analysis, PCS is independently associated with SDAI (coeff 0.22467, 95%CI 0.923 to 0.357, p=0.001), whilst anxious and depressive symptoms are not. The same results were reported for the PCS domains helplessness (coeff 0.5947942, 95%CI 0.3032154 to 0.8863731, p&lt;0.0001) and rumination (coeff 0.4921229, 95%CI 0.2190804 to 0.7651653, p=0.001) but not for magnification (p=0.4). <h3>Conclusion:</h3> In our study, we found that PC, a maladaptive cognitive perception of pain, negatively impacts disease activity, thus limiting the achievement of therapeutic targets. We established a significant association between PCS (total PCS and domains: rumination, magnification, helplessness) and SDAI levels, confirming PC's interference with achieving low disease activity and remission. Notably, PC is associated with SDAI independently from anxious and depressive symptoms, the latter previously associated with disease activity. Thus, PC might mediate the relationship between depressive symptoms and RA disease activity. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>