AB0158 PSYCHOEMOTIONAL STATE AND INFLAMMATION AS PREDICTORS FOR MUSCULOSKELETAL PAIN IN PATIENTS WITH INFLAMMATORY ARTHRITIS AND COVID-19
Authors: S. Bogdanova-Petrova, T. Shivacheva, S. Dimitrov, R. Moraliyska, G. Gerganov, S. Hristova, Z. Dimova, M. Markov, T. Georgiev
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Musculoskeletal pain is a prevalent symptom in various diseases. Both rheumatic and nonrheumatic conditions may manifest with joint or muscle pain, influenced by diverse mechanisms dependent on the pain's acute or chronic nature. Biochemical reactions, along with biological, physiological, and social factors, contribute to its pathogenesis [1]. While inflammatory disease activity predominantly determines pain presence, subjective factors linked to the psycho-emotional state impact the assessment of pain severity. <h3>Objectives:</h3> This study aims to assess the prevalence and intensity of musculoskeletal pain symptoms (arthralgia and myalgia) and their association with anxiety and depressive mood disorders in a Bulgarian cohort of patients diagnosed with inflammatory arthritis (IA) or COVID-19. <h3>Methods:</h3> A single-center, observational study involved two patient cohorts: one with inflammatory joint diseases (RA, AS, and PsA) and patients with moderate or severe SARS-CoV-2 infection admitted to the COVID-19 rheumatology department. The first cohort comprised patients with chronic musculoskeletal pain, while the second had acute onset. Diagnostic criteria for IA were applied, and bDMARD treatment was administered. COVID-19 patients confirmed by laboratory tests underwent pain assessment using Visual Analogue Scales (VAS) and depression/anxiety evaluation via Zung self-report scales (SDS and SAS). Descriptive statistics, one-Sample T test, correlation, and linear regression analyses were conducted with a significance level of p &lt; 0.01. <h3>Results:</h3> In the present study, 364 participants were included, with 130 patients representing IA – encompassing RA, PsA and AS – and 234 patients diagnosed with COVID-19, constituting 35.7% and 64.3% of the cohort, respectively. Patients with COVID-19 reported more intense muscle pain, whereas those with inflammatory joint disease exhibited heightened joint pain. Gender-stratified analysis using VAS demonstrated that women with COVID-19 experienced significantly more pain in both joint (р=0.019) and muscle (р=0.021) categories, while no significant differences were noted in the IA cohort (р=0.177 and р=0.717). Psychological aspects also played a substantial role, as women in both cohorts scored higher on anxiety and depression scales, with significant differences (p&lt;0.001 for depression scale and p=0.001 for anxiety scale in IA population vs p=0.008 for depression scale and p=0.002 for anxiety scale in COVID-19 population). Notably, patients with moderate to severe COVID-19 exhibited elevated depression and anxiety rates correlating with age and gender. Depression and anxiety, assessed using SDS and SAS, explained 50.0% of the variation in musculoskeletal pain for COVID-19 patients (46.0% for joint pain and 50.0% for muscle pain), whereas in IA patients, these factors accounted for less variation (12.2% for joint pain and 5.5% for muscle pain). Inflammatory indicators explained about 8% of the variation for IA patients (R square 7.8% for joint pain and R square 8.1% for muscle pain) and even less for the COVID-19 population (R square 3.5% for joint pain and R square 4.4% for muscle pain). <h3>Conclusion:</h3> Musculoskeletal pain is a prevalent clinical manifestation across various diseases, presenting a challenge for patients and physicians alike. The correlation of pain intensity with anxiety and depressive symptoms outweighs its association with inflammatory markers in both chronic inflammatory diseases and COVID-19 populations. <h3>REFERENCES:</h3> [1] S. Bogdanova-Petrova, T. Shivacheva, T. Georgiev, P. Petrov. Pаin in COVID-19 and features of pathogenetic molecular mechanisms, Rheumatology (Bulgaria). 2022; 30(4):28-33. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>