Pain in Biologic-Treated Rheumatoid Arthritis Patients: The Role of Illness Perception Before and After the COVID-19 Pandemic.
COVID‐19
fatigue
illness perception
pain
pandemic preparedness
rheumatoid arthritis
Journal
Musculoskeletal care
ISSN: 1557-0681
Titre abrégé: Musculoskeletal Care
Pays: England
ID NLM: 101181344
Informations de publication
Date de publication:
Dec 2024
Dec 2024
Historique:
received:
18
09
2024
accepted:
23
09
2024
medline:
14
10
2024
pubmed:
14
10
2024
entrez:
13
10
2024
Statut:
ppublish
Résumé
We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients. We included 103 RA patients (81.6% females; mean age 56.1 ± 13.8 years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data. Our results showed significantly worsened pain in the data collected post-pandemic (p ≤ 0.05). Pre-pandemic, the final regression models showed an association between functional disability (β = 0.24; p ≤ 0.05), illness perception (β = 0.34; p ≤ 0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β = 0.33; p ≤ 0.01) and illness perception (β = 0.36; p ≤ 0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic. Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients.
METHODS
METHODS
We included 103 RA patients (81.6% females; mean age 56.1 ± 13.8 years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data.
RESULTS
RESULTS
Our results showed significantly worsened pain in the data collected post-pandemic (p ≤ 0.05). Pre-pandemic, the final regression models showed an association between functional disability (β = 0.24; p ≤ 0.05), illness perception (β = 0.34; p ≤ 0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β = 0.33; p ≤ 0.01) and illness perception (β = 0.36; p ≤ 0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic.
CONCLUSION
CONCLUSIONS
Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1958Subventions
Organisme : Agentúra na Podporu Vྭskumu a Vྭvoja/Slovak Research and Development Agency
ID : APVV-22-0587
Informations de copyright
© 2024 John Wiley & Sons Ltd.
Références
Arnett, F. C., S. M. Edworthy, D. A. Bloch, et al. 1988. “The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis.” Arthritis & Rheumatism 31, no. 3: 315–324. https://doi.org/10.1002/art.1780310302.
Balchin, C., A. L. Tan, O. J. Wilson, J. McKenna, and A. Stavropoulos‐Kalinoglou. 2022. “Participation in Physical Activity Decreased More in People With Rheumatoid Arthritis Than the General Population During the COVID‐19 Lockdown: A Cross‐Sectional Study.” Rheumatology International 42, no. 2: 241–250. https://doi.org/10.1007/s00296‐021‐05054‐4.
Bas, D. B., J. Su, G. Wigerblad, and C. I. Svensson. 2016. “Pain in Rheumatoid Arthritis: Models and Mechanisms.” Pain Management 6, no. 3: 265–284. https://doi.org/10.2217/pmt.16.4.
Broadbent, E., K. J. Petrie, J. Main, and J. Weinman. 2006. “The Brief Illness Perception Questionnaire.” Journal of Psychosomatic Research 60, no. 6: 631–637. https://doi.org/10.1016/j.jpsychores.2005.10.020.
Bruce, B., and J. F. Fries. 2005. “The Health Assessment Questionnaire (HAQ).” Clinical & Experimental Rheumatology 23, no. 5: S14.
Carpenter, L., R. Barnett, P. Mahendran, et al. 2020. “Secular Changes in Functional Disability, Pain, Fatigue and Mental Well‐Being in Early Rheumatoid Arthritis. A Longitudinal Meta‐Analysis.” Seminars in Arthritis and Rheumatism 50, no. 2: 209–219. https://doi.org/10.1016/j.semarthrit.2019.08.006.
Cohen, S. P., L. Vase, and W. M. Hooten. 2021. “Chronic Pain: An Update on Burden, Best Practices, and New Advances.” Lancet 397, no. 10289: 2082–2097. https://doi.org/10.1016/S0140‐6736(21)00393‐7.
de Heer, E. W., M. M. Gerrits, A. T. Beekman, et al. 2014. “The Association of Depression and Anxiety With Pain: A Study From NESDA.” PLoS One 9, no. 10: e106907. https://doi.org/10.1371/journal.pone.0106907.
Di Iorio, M., C. E. Cook, K. M. M. Vanni, et al. 2022. “DMARD Disruption, Rheumatic Disease Flare, and Prolonged COVID‐19 Symptom Duration After Acute COVID‐19 Among Patients With Rheumatic Disease: A Prospective Study.” Seminars in Arthritis and Rheumatism 55: 152025. https://doi.org/10.1016/j.semarthrit.2022.152025.
Eberhard, A., S. Bergman, T. Mandl, et al. 2021. “Predictors of Unacceptable Pain With and Without Low Inflammation Over 5 Years in Early Rheumatoid Arthritis—An Inception Cohort Study.” Arthritis Research and Therapy 23, no. 1: 169. https://doi.org/10.1186/s13075‐021‐02550‐7.
Eriksen, T. E., W. K. H. Dinesen, L. Uhrenholt, L. Dreyer, K. Duch, and S. Kristensen. 2022. “Isolation in Patients With Inflammatory Rheumatic Diseases During COVID‐19 Pandemic Compared to Healthy Individuals: A Questionnaire Survey.” Rheumatology International 42, no. 5: 783–790. https://doi.org/10.1007/s00296‐022‐05111‐6.
Fauci, A. S., and G. K. Folkers. 2023. “Pandemic Preparedness and Response: Lessons From COVID‐19.” Journal of Infectious Diseases 228, no. 4: 422–425. https://doi.org/10.1093/infdis/jiad095.
Faul, F., E. Erdfelder, A. Buchner, and A. G. Lang. 2009. “Statistical Power Analyses Using G*Power 3.1: Tests for Correlation and Regression Analyses.” Behavior Research Methods 41, no. 4: 1149–1160. https://doi.org/10.3758/BRM.41.4.1149.
Geenen, R., C. L. Overman, R. Christensen, et al. 2018. “EULAR Recommendations for the Health Professional's Approach to Pain Management in Inflammatory Arthritis and Osteoarthritis.” Annals of the Rheumatic Diseases 77, no. 6: 797–807. https://doi.org/10.1136/annrheumdis‐2017‐212662.
Gonzalez‐Rangel, J., B. Perez‐Munoz, D. Casillas‐Santos, et al. 2021. “Mental Health in Patients With Rheumatic Diseases Related to COVID‐19 Pandemic: Experience in a Tertiary Care Center in Latin America.” Lupus 30, no. 12: 1879–1887. https://doi.org/10.1177/09612033211038052.
Gwinnutt, J. M., S. Norton, K. L. Hyrich, et al. 2021. “Changes in the Illness Perceptions of Patients With Rheumatoid Arthritis Over the First Year of Methotrexate Therapy.” Rheumatology 60, no. 5: 2355–2365. https://doi.org/10.1093/rheumatology/keaa615.
Hsieh, E., D. Dey, R. Grainger, et al. 2024. “Global Perspective on the Impact of the COVID‐19 Pandemic on Rheumatology and Health Equity.” Arthritis Care & Research 76, no. 1: 22–31. https://doi.org/10.1002/acr.25169.
Husivargova, A., E. Sulkers, Z. Macejova, et al. 2022. “Self‐reported Health Problems and Patients´ Preferences for Non‐Pharmacological Interventions in Rheumatoid Arthritis.” Ceska a Slovenska Psychiatrie 118, no. 4: 149–156.
Huskisson, E. C. 1974. “Measurement of Pain.” Lancet 2, no. 7889: 1127–1131. https://doi.org/10.1016/s0140‐6736(74)90884‐8.
Javorka, K. E. A. 2001. “Lekárska Fyziológia. Učebnica Pre Lekárske Fakulty.” Martin: Osveta: 678: 80‐8063‐023‐2.
Kotsis, K., P. V. Voulgari, N. Tsifetaki, A. A. Drosos, A. F. Carvalho, and T. Hyphantis. 2014. “Illness Perceptions and Psychological Distress Associated With Physical Health‐Related Quality of Life in Primary Sjogren's Syndrome Compared to Systemic Lupus Erythematosus and Rheumatoid Arthritis.” Rheumatology International 34, no. 12: 1671–1681. https://doi.org/10.1007/s00296‐014‐3008‐0.
Kroenke, K., R. L. Spitzer, and J. B. Williams. 2001. “The PHQ‐9: Validity of a Brief Depression Severity Measure.” Journal of General Internal Medicine 16, no. 9: 606–613. https://doi.org/10.1046/j.1525‐1497.2001.016009606.x.
Lim, S. L., V. Y. Tay, A. Bhullar, et al. 2021. “A Questionnaire‐Based Survey on Depression and Anxiety Among Rheumatology Patients During the COVID‐19 Pandemic.” Patient’s Perspective 36, no. 5: e305. https://doi.org/10.5001/omj.2022.34.
Lochting, I., E. Fjerstad, and A. M. Garratt. 2013. “Illness Perceptions in Patients Receiving Rheumatology Rehabilitation: Association With Health and Outcomes at 12 Months.” BMC Musculoskeletal Disorders 14, no. 28: 1–7. https://doi.org/10.1186/1471‐2474‐14‐28.
Maccaro, A., C. Audia, K. Stokes, et al. 2023. “Pandemic Preparedness: A Scoping Review of Best and Worst Practices From COVID‐19.” Healthcare (Basel) 11, no. 18: 2572. https://doi.org/10.3390/healthcare11182572.
Mathias, K., A. Amarnani, N. Pal, et al. 2021. “Chronic Pain in Patients With Rheumatoid Arthritis.” Current Pain and Headache Reports 25, no. 9: 59. https://doi.org/10.1007/s11916‐021‐00973‐0.
Nagy, G., N. M. T. Roodenrijs, P. M. J. Welsing, et al. 2022. “EULAR Points to Consider for the Management of Difficult‐to‐Treat Rheumatoid Arthritis.” Annals of the Rheumatic Diseases 81, no. 1: 20–33. https://doi.org/10.1136/annrheumdis‐2021‐220973.
O'Brien, C. M., N. Ntoumanis, J. L. Duda, et al. 2021. “Pain and Fatigue Are Longitudinally and Bi‐Directionally Associated With More Sedentary Time and Less Standing Time in Rheumatoid Arthritis.” Rheumatology 60, no. 10: 4548–4557. https://doi.org/10.1093/rheumatology/keab029.
Parsirad, M., S. Oomen‐Lochtefeld, B. Suerig, and C. Wang. 2023. “Has the COVID 19 Pandemic Impacted the Management of Chronic Musculoskeletal Pain?” Current Rheumatology Reports 25, no. 7: 128–143. https://doi.org/10.1007/s11926‐023‐01103‐y.
Senaviratna, N. A. M. R., and A. T. M. J. Cooray. 2019. “Diagnosing Multicollinearity of Logistic Regression Model.” Asian Journal of Probability and Statistics 5, no. 2: 1–9. https://doi.org/10.9734/ajpas/2019/v5i230132.
Shim, E. J., D. Jeong, Y. W. Song, S. H. Lee, N. J. Kim, and B. J. Hahm. 2020. “A Network Analysis of the Brief Illness Perception Questionnaire in Patients With Rheumatic Diseases and Human Immunodeficiency Virus Infection.” Psychology and Health 35, no. 7: 838–853. https://doi.org/10.1080/08870446.2019.1686150.
Smets, E. M. A., B. Garssen, B. Bonke, and J. C. J. M. De Haes. 1995. “The Multidimensional Fatigue Inventory (MFI) Psychometric Qualities of an Instrument to Assess Fatigue.” Journal of Psychosomatic Research 39, no. 3: 315–325. https://doi.org/10.1016/0022‐3999(94)00125‐O.
Smolen, J., R. B. M. Landewe, S. A. Bergstra, et al. 2022. “EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease‐Modifying Antirheumatic Drugs: 2022 Update.” Annals of the Rheumatic Diseases 82: 1–16. https://doi.org/10.1136/ard‐2022‐223356.
Spitzer, R. L., K. Kroenke, J. B. W. Williams, and B. Lowe. 2006. “A Brief Measure for Assessing Generalized Anxiety Disorder.” Archives of Internal Medicine 166, no. 10: 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Szilasiova, A., Z. Macejova, I. Nagyova, M. Kovarova, A. Beresova, and J. Szilasiova. 2002. “Reliabity and Validity of the Slovak Version and Modification of the Stanford Health Assessment Questionnaire‐Functional Disability Index (HAQ) in Patient With Rheumatoid Arthritis (RA).” Vnitrní Lékarství 48, no. 1: 8–16.
Tanski, W. 2021. “The Role of Clinical Activity, Loneliness, and Satisfaction With E‐Health Services as Factors Affecting Quality of Life in Patients With Rheumatoid Arthritis During the SARS‐CoV‐2 Pandemic.” Psychology Research and Behavior Management 14: 1581–1590. https://doi.org/10.2147/PRBM.S332141.
Timkova, V., P. Mikula, M. Fedicova, J. Szilasiova, and I. Nagyova. 2021. “Psychological Well‐Being in People With Multiple Sclerosis and Its Association With Illness Perception and Self‐Esteem.” Multiple Sclerosis and Related Disorders 54: 103114. https://doi.org/10.1016/j.msard.2021.103114.
Tuna, H. I., G. B. Alparslan, and S. Yilmaz. 2022. “Pain and Affected Symptoms of Patients With Rheumatoid Arthritis During COVID‐19 Period.” Pain Management Nursing 23, no. 1: 43–47. https://doi.org/10.1016/j.pmn.2021.08.004.
Van der Heijde, D. M., M. A. Van't Hof, P. L. Van Riel, M. A. Van Leeuwen, M. H. Van Rijswijk, and L. B. Van de Putte. 1992. “Validity of Single Variables and Composite Indices for Measuring Disease Activity in Rheumatoid Arthritis.” Annals of the Rheumatic Diseases 51, no. 2: 177–181. https://doi.org/10.1136/ard.51.2.177.