Abstract
Background: catastrophizing is conceptualized as a negative cognitive–affective response to an anxiety-provoking stimulus, especially anticipated or actual pain. Catastrophizing can be assessed quickly using a validated questionnaire: the Pain Catastrophizing Scale (PCS)1. Catastrophizing plays a role in maintaining chronic pain and is associated with several pain-related outcomes in osteoarthritis and low back pain.Objectives: to assess the prevalence of catastrophizing and associated factors in rheumatoid arthritis (RA).Methods: we performed an observational, prospective, bi-centric study. All patients aged 18 or over with RA and fulfilling the ACR-EULAR 2010 criteria were consecutively included. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires for disease activity (DAS28), function (HAQ), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), fibromyalgia (FiRST), insomnia (ISI) and catastrophizing scores (PCS). Statistical analysis included the samples t-test, one-way variance analysis, the Spearman’s correlation test, the Chi2 test, Fisher’s exact test, the Wilcoxon test, multivariate linear regression (considering catastrophizing as a continuous variable) and multivariate logistics regression (considering catastrophizing as a categorical variable: PCS ≥20 = high level catastrophizing).Results: from September 2019 to March 2020, 201 patients with RA were included: 78.1% were women and the median age was 63.0 years. In all, 64.1% of patients were RF+, 65.7% ACPA+, and 46% had erosive disease. Median DAS28 CRP was 2.9 [2.1-4.0]. with 45% of patients in remission, 14.8% with low, 31.2% moderate and 9 % high activity. The majority of patients (92%) had a disease lasting for more than 2 years.The prevalence of a PCS score ≥20 was 48.0% [41.0;54.9]. The median PCS score was 18 [7-28]. In multivariate logistics regression, high-level catastrophizing was significantly associated with DAS28-CRP (OR=1.61 [1.18-2.20]), HADS anxiety score (OR=1.25 [1.11-1.40]) and the HADS depression score (OR=1.19 [1.07-1.33]). In multivariate linear regression, catastrophizing was significantly associated with the HADS anxiety score (p<0.0001), HADS depression score (p=0.0055), HAQ (p=0.0015) and the ISI insomnia score (p=0.005).Conclusion: almost half the patients with RA were high catastrophizers. Catastrophizing is linked to anxiety, depression, disease activity, function impairment and insomnia. It may be interesting to detect catastrophizing in order to improve the management of our patients.