Socio-demographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts

Abstract

Objective To determine whether sociodemographic factors are associated with heterogeneity in pain evolution in inflammatory rheumatic diseases (IRDs) after accounting for disease-specific characteristics in a system with universal health care. Methods This analysis included the data from two prospective observational cohorts of early IRDs (ESPOIR for early rheumatoid arthritis (RA) and DESIR for early spondyloarthritis (SpA)). Data on pain was measured respectively at 13 and 9 occasions spanning 10 and 6 years of follow-up using Short-Form 36 bodily pain amongst 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterise differences in pain evolution as a function of age (tertiles), sex, ethnicity, education, marital, and professional status after accounting for disease-related, treatment, lifestyle, and health factors. Results While transitioning from early (disease duration ≤6 months for RA and ≤3 years for SpA) to long-standing disease, differences in pain evolution emerged as a function of age (p< 0.001), sex (p= 0.050), and ethnicity (p= 0.001) in RA, and as a function of age (p= 0.048) in SpA; younger age, males, and Caucasians exhibited lower pain in the latter phases of both diseases. Highly educated (RA, β=-3.8, p= 0.007; SpA, β=-6.0, p< 0.001) in both diseases, and Caucasians (β=-5.6, p= 0.021) in SpA presented with low pain early in the disease, with no changes throughout disease course. Conclusion Those older, females, non-Caucasians and lowly educated have worse pain in early and/or long-standing IRDs despite universally accessible health-care. Early identification of at-risk population and implementation of multi-disciplinary strategies may reduce patient-reported health outcome disparities.

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study

“… 39 However, substantial evidence has now significantly broadened this perspective, highlighting the equal importance of biological, psychological and social determinants in understanding pain. 21 , 40 , 41 This holistic view is reflected in the biopsychosocial model of chronic pain. 22 As well as the identification of specific pain descriptors, recognising the need to assess the interplay between biological, psychological and social factors in each individual's experience of pain has important implications for stratified pain treatment, setting the path for more effective pain management.…”

“…Historically, pain was understood to correlate directly with the underlying biological pathology, and psychological factors were considered only in the absence of identifiable physical causes 39 . However, substantial evidence has now significantly broadened this perspective, highlighting the equal importance of biological, psychological and social determinants in understanding pain 21,40,41 . This holistic view is reflected in the biopsychosocial model of chronic pain 22 .…”

Collating the voice of people with autoimmune diseases: Methodology for the Third Phase of the COVAD Studies

“…Our results will ultimately inform strategies to strengthen patient self-management, reduce anxiety surrounding health conditions, and reduce morbidity and mortality from adverse health outcomes. In addition, early identification of at-risk populations and implementation of multidisciplinary strategies may reduce patient-reported health outcome disparities [ 8 ].…”

“…Additionally, sociodemographic factors in patients with AIRDs have been linked to higher pain levels, deteriorating mental health, and overall poorer quality of life [ 2 , 8 ]. These findings underscore the importance of considering the broader context of a patient's life and socioeconomic situation when providing care and treatment for AIRDs.…”

Trajectories of self-reported pain-related health outcomes and longitudinal effects on medication use in rheumatoid arthritis: a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD)

“…These findings are similar to those from a large French observational study, which highlighted the temporal implications of pain heterogeneity and sociodemographic characteristics throughout the disease course. 44 Over the last two decades, the comorbidity burden at the time of RA diagnosis has risen, implying the need for early identification and better treatment tailoring for these at-risk individuals. 45 Additionally, our study findings have demonstrated high proportions of self-reported depression in those with poorer pain-related health status.…”