Structural equation modelling provides insights to understand the construct of chronic pain in women with rheumatoid arthritis

Abstract

Objectives We aimed to adopt a multidimensional approach and investigate the interconnections between biomarkers (cytokines, matrix metalloproteinases, and cortisol) and psychosocial aspects considering pain acceptance, the individual construct of pain perception in terms of blood inflammation biomarkers, anxiety, self-efficacy, and functional performance and to define the quality of life (QoL) in women with rheumatoid arthritis (RA). Methods An observational cross-sectional study with a total of 42-RA participants, with chronic pain and 42-women without rheumatic diseases or chronic pain were included. A structural equation model was used to investigate the association between independent variables. Results Women with RA presented high blood biomarker levels, representing an intense inflammatory process. The participants with RA reported moderate pain most of the time, a worsening QoL, functionality, engagement in activities, and a willingness to live with pain and self-efficacy. It was found that the higher the chronic pain, the greater the intensity of pain perceived by these women with RA, as well as, the worse the functionality, the higher the perceived pain. Conclusions The exacerbation of pain perception leads to worsening of the experience of chronic pain. The new construct of pain experience should include functionality as a crucial factor in understanding the mechanisms underlying pain.

Examining pain severity in women with rheumatoid arthritis: the impact of pain self-efficacy and perceived partner’s emotional support

“… Mittinty et al (2018) argue that high self-efficacy is one of the most important factors in reducing the severity of chronic pain. Indeed, many researchers note that higher self-efficacy is associated with less intense pain, better adjustment to pain, and improved pain control ( Miles et al, 2011 ; Ruben et al, 2017 ; Vendrusculo-Fangel et al, 2022 ). Sturgeon and Zautra (2010) also observed that high self-efficacy not only reduces the severity of pain in the present moment but also predicts lower pain severity in the future.…”

“…Consequently, researchers inquire about the factors contributing to such differences among patients and the phenomena associated with better adjustment and less severe pain. Several studies suggest that various psychosocial factors may influence pain manifestation among patients with RA ( Bergström et al, 2023 ; Bouhouche et al, 2017 ; Rezaei et al, 2014 ; Vendrusculo-Fangel et al, 2022 ).…”

Metalloproteinases as Biomarkers and Sociomarkers in Human Health and Disease

“…In the case of inflammatory diseases, four articles have studied the pathological mechanisms involved in MMP in rheumatoid arthritis (RA) associated with the psychosocial sphere [90,91].…”

“…Vendrusculo et al [91] conducted an observational cross-sectional study to provide a comprehensive description of chronic pain in Brazilian women with rheumatoid arthritis (RA) compared to women without RA or chronic pain, who will serve as the control group.…”

“…According to Vendrusculo et al, collagenases MMP-2 and -9, which degrade collagens and cleave ECM proteins, play a crucial role in joint destruction and the development of pain during RA progression, and therefore their inhibitors may represent a new therapeutic treatment of pain in patients with rheumatoid arthritis [91].…”