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

Sushmithadev Kumaradev, Christian Roux, Jérémie Sellam, Serge Perrot, Thao Pham, Aline Dugravot, Anna Molto, Sushmithadev Kumaradev, Christian Roux, Jérémie Sellam, Serge Perrot, Thao Pham, Aline Dugravot, Anna Molto

Abstract

Objective: To determine whether socio-demographic 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 RA and DESIR for early SpA). Data on pain was measured, respectively, on 13 and 9 occasions spanning 10 and 6 years of follow-up using the Short-Form 36 bodily pain score for 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterize 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 participants (RA, β = -3.8, P = 0.007; SpA, β = -6.0, P < 0.001) for both diseases, and Caucasians (β = -5.6, P = 0.021) for SpA presented with low pain early in the disease, with no changes throughout disease course.

Conclusion: Being older, female, non-Caucasian and having lower education was found to be associated with worse pain in early and/or long-standing IRDs, despite universally accessible health-care. Early identification of at-risk populations and implementation of multidisciplinary strategies may reduce patient-reported health outcome disparities.

Trial registration registrations: ESPOIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03666091. DESIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01648907.

Keywords: pain evolution; pain outcome; rheumatoid arthritis; socio-demographic factors; spondyloarthritis.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig. 1
Fig. 1
Evolution of SF-36 bodily pain by socio-demographic subgroups from inclusion to up to 10 years in RA (ESPOIR cohort) *P for difference in pain trajectories/evolution (drawn from testing the interactions between socio-demographic factor and slope terms using the Wald test). Analysis adjusted for socio-demographic factors (sex, age, ethnicity, education, professional and marital status assessed at inclusion) and their interaction with slope terms (time, time2 and time3), and disease-related (symptom duration, ESR, tender and swollen joint count, presence of radiographic structural lesions, RF positivity, ACPA positivity), treatment (anti-inflammatory and analgesic agents), lifestyle-related (BMI, smoking, and alcohol consumption status) and health factors (rheumatic disease comorbidity index). Disease-related, treatment, lifestyle-related and health factors were time-dependent, with some exceptions (symptom duration and ACPA positivity at baseline and their interactions with slope terms) were used in analysis. The tables beneath the figures indicate the total number of participants by socio-demographic subgroups contributing at least once to the analysis for every 2 years from year 0 to 10. Estimates came from Margins command in STATA. SF-36, short-form 36.
Fig. 2
Fig. 2
Evolution of differences in SF-36 bodily pain by socio-demographic subgroups in RA and SpA Analysis adjusted for socio-demographic factors (sex, age, ethnicity, education, professional and marital status assessed at inclusion) and their interaction with slope terms (time, time2 and time3), and disease-related, treatment, lifestyle-related, and health factors. The green line represents the ESPOIR cohort and the red line the DESIR cohort. SF-36, short-form 36
Fig. 3
Fig. 3
Evolution of SF-36 bodily pain by socio-demographic subgroups from inclusion to up to 6 years in SpA (DESIR cohort) * P for difference in pain trajectories/evolution (drawn from testing the interactions between socio-demographic factor and slope terms using Wald test). Analysis adjusted for socio-demographic factors (sex, age, ethnicity, education, professional and marital status assessed at inclusion) and their interaction with slope terms (time, time2, and time3), and disease-related (symptom duration, CRP, arthritis, synovitis, and enthesitis indices, presence of sacroilitis, human leukocyte antigen B27 positivity), treatment (anti-inflammatory and analgesic agents), lifestyle-related (BMI, smoking, and alcohol consumption status), and health factors (rheumatic disease comorbidity index). Disease-related, treatment, lifestyle-related and health factors were time-dependant with some exceptions (symptom duration, presence of sacroilitis and human leukocyte antigen B 27 positivity at baseline and their interaction with slope terms) were used in analysis. The tables beneath the figures indicate the total number of participants by socio-demographic sub-groups contributing at least once to the analysis by every year from year 0 to 6. Estimates came from Margins command in STATA.

References

    1. Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol 2014;10:581–92.
    1. Bidad K, Gracey E, Hemington KS et al. Pain in ankylosing spondylitis: a neuro-immune collaboration. Nat Rev Rheumatol 2017;13:410–20.
    1. Carpenter L, Barnett R, Mahendran P et al. Secular changes in functional disability, pain, fatigue and mental well-being in early rheumatoid arthritis. A longitudinal meta-analysis. Semin Arthritis Rheum 2020;50:209–19.
    1. Carpenter L, Nikiphorou E, Kiely PDW et al. Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis. Rheumatology (Oxford) 2020;59:2381–91.
    1. Matcham F, Scott IC, Rayner L et al. The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum 2014;44:123–30.
    1. Yang X, Fan D, Xia Q et al. The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res 2016;25:2711–23.
    1. McWilliams DF, Dawson O, Young A et al. Discrete trajectories of resolving and persistent pain in people with rheumatoid arthritis despite undergoing treatment for inflammation: results from three UK cohorts. J Pain 2019;20:716–27.
    1. Vergne-Salle P, Pouplin S, Trouvin AP et al. The burden of pain in rheumatoid arthritis: impact of disease activity and psychological factors. Eur J Pain 2020;24:1979–89.
    1. Perrot S, Dieude P, Perocheau D, Allanore Y. Comparison of pain, pain burden, coping strategies, and attitudes between patients with systemic sclerosis and patients with rheumatoid arthritis: a cross-sectional study. Pain Med 2013;14:1776–85.
    1. Trouvin AP, Curis E, Nicolis I, Beller C, Perrot S. Experience of pain is correlated to treatment profile in patients with rheumatoid arthritis. Differentiating 5 clusters of patients in a national cohort of 1100 women with rheumatoid arthritis. Joint Bone Spine 2020;87:675–6.
    1. Wolfe F, Michaud K. Assessment of pain in rheumatoid arthritis: minimal clinically significant difference, predictors, and the effect of anti-tumor necrosis factor therapy. J Rheumatol 2007;34:1674–83.
    1. Waltz M, Kriegel W, van’t Pad Bosch P. The social environment and health in rheumatoid arthritis: marital quality predicts individual variability in pain severity. Arthritis Care Res 1998;11:356–74.
    1. McWilliams DF, Walsh DA. Factors predicting pain and early discontinuation of tumour necrosis factor-alpha-inhibitors in people with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. BMC Musculoskelet Disord 2016;17:337.
    1. Mogard E, Lindqvist E, Bremander A, Bergman S. Risk factors for development and persistence of chronic widespread pain in spondyloarthritis: a population-based two-year follow-up study. Scand J Rheumatol 2019;48:460–8.
    1. Barnabe C, Bessette L, Flanagan C et al. Sex differences in pain scores and localization in inflammatory arthritis: a systematic review and metaanalysis. J Rheumatol 2012;39:1221–30.
    1. Swinnen TW, Westhovens R, Dankaerts W, de Vlam K. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther 2018;20:156.
    1. McWilliams DF, Zhang W, Mansell JS et al. Predictors of change in bodily pain in early rheumatoid arthritis: an inception cohort study. Arthritis Care Res (Hoboken) 2012;64:1505–13.
    1. Ten Klooster PM, Vonkeman HE, Oude Voshaar MA et al. Predictors of satisfactory improvements in pain for patients with early rheumatoid arthritis in a treat-to-target study. Rheumatology (Oxford) 2015;54:1080–6.
    1. Bruce B, Fries JF, Murtagh KN. Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study. J Rheumatol 2007;34:1475–9.
    1. Vilen L, Baldassari AR, Callahan LF. Socioeconomic burden of pain in rheumatic disease. Clin Exp Rheumatol 2017;35(Suppl 107):26–31.
    1. Baldassari AR, Cleveland RJ, Jonas BL et al. Socioeconomic disparities in the health of African Americans with rheumatoid arthritis from the southeastern United States. Arthritis Care Res (Hoboken) 2014;66:1808–17.
    1. Baldassari AR, Cleveland RJ, Luong MN et al.; Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis. Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status. BMC Musculoskelet Disord 2016;17:10.
    1. Andersson ML, Svensson B, Bergman S. Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years. J Rheumatol 2013;40:1977–85.
    1. Ahlstrand I, Thyberg I, Falkmer T, Dahlström Ö, Björk M. Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project. Scand J Rheumatol 2015;44:259–64.
    1. Andersson MLE, Forslind K, Hafstrom I; BARFOT Study Group. Patients with early rheumatoid arthritis in the 2000s have equal disability and pain despite less disease activity compared with the 1990s: data from the BARFOT study over 8 years. J Rheumatol 2017;44:723–31.
    1. Dobkin PL, Liu A, Abrahamowicz M et al. Predictors of pain for patients with early inflammatory polyarthritis. Arthritis Care Res (Hoboken) 2013;65:992–9.
    1. Combe B, Rincheval N. Early lessons from the recent-onset rheumatoid arthritis cohort ESPOIR. Joint Bone Spine 2015;82:13–7.
    1. Dougados M, Etcheto A, Molto A et al.; DESIR cohort. Clinical presentation of patients suffering from recent onset chronic inflammatory back pain suggestive of spondyloarthritis: the DESIR cohort. Joint Bone Spine 2015;82:345–51.
    1. Ruta DA, Hurst NP, Kind P, Hunter M, Stubbings A. Measuring health status in British patients with rheumatoid arthritis: reliability, validity and responsiveness of the short form 36-item health survey (SF-36). Br J Rheumatol 1998;37:425–36.
    1. Linde L, Sørensen J, Ostergaard M, Hørslev-Petersen K, Hetland ML. Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol 2008;35:1528–37.
    1. Sendlbeck M, Araujo EG, Schett G, Englbrecht M. Psychometric properties of three single-item pain scales in patients with rheumatoid arthritis seen during routine clinical care: a comparative perspective on construct validity, reproducibility and internal responsiveness. RMD Open 2015;1:e000140.
    1. Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.
    1. England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K. Validation of the rheumatic disease comorbidity index. Arthritis Care Res (Hoboken) 2015;67:865–72.
    1. Ward MM, Guthrie LC, Alba MI. Clinically important changes in short form 36 health survey scales for use in rheumatoid arthritis clinical trials: the impact of low responsiveness. Arthritis Care Res (Hoboken) 2014;66:1783–9.
    1. Sokka T, Toloza S, Cutolo M et al. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther 2009;11:R7.
    1. Austad C, Kvien TK, Olsen IC, Uhlig T. Health status has improved more in women than in men with rheumatoid arthritis from 1994 to 2009: results from the Oslo rheumatoid arthritis register. Ann Rheum Dis 2015;74:148–55.
    1. Webers C, Essers I, Ramiro S et al. Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. Rheumatology (Oxford) 2016;55:419–28.
    1. Mogard E, Bremander A, Lindqvist E, Bergman S. Prevalence of chronic widespread pain in a population-based cohort of patients with spondyloarthritis – a cross-sectional study. BMC Rheumatol 2018;2:11.
    1. Eberly L, Richter D, Comerci G et al. Psychosocial and demographic factors influencing pain scores of patients with knee osteoarthritis. PLoS One 2018;13:e0195075.
    1. Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther 2011;13:211.
    1. Jiang X, Sandberg ME, Saevarsdottir S et al. Higher education is associated with a better rheumatoid arthritis outcome concerning for pain and function but not disease activity: results from the EIRA cohort and Swedish rheumatology register. Arthritis Res Ther 2015;17:317.
    1. Evers AW, Kraaimaat FW, Geenen R, Jacobs JW, Bijlsma JW. Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav Res Ther 2003;41:1295–310.
    1. Andersson ML, Bergman S, Soderlin MK. The effect of socioeconomic class and immigrant status on disease activity in rheumatoid arthritis: data from BARFOT, a multi-centre study of early RA. Open Rheumatol J 2013;7:105–11.
    1. Yang G, Bykerk VP, Boire G et al.; The CATCH Investigators. Does socioeconomic status affect outcomes in early inflammatory arthritis? Data from a Canadian multisite suspected rheumatoid arthritis inception cohort. J Rheumatol 2015;42:46–54.
    1. Reese JB, Somers TJ, Keefe FJ, Mosley-Williams A, Lumley MA. Pain and functioning of rheumatoid arthritis patients based on marital status: is a distressed marriage preferable to no marriage? J Pain 2010;11:958–64.
    1. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013;111:52–8.
    1. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag 2012;2:219–30.
    1. El Tumi H, Johnson MI, Dantas PBF, Maynard MJ, Tashani OA. Age-related changes in pain sensitivity in healthy humans: a systematic review with meta-analysis. Eur J Pain 2017;21:955–64.
    1. Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: a meta-analytic review. Psychol Bull 2014;140:140–87.
    1. Poleshuck EL, Green CR. Socioeconomic disadvantage and pain. Pain 2008;136:235–8.
    1. Wandner LD, Scipio CD, Hirsh AT, Torres CA, Robinson ME. The perception of pain in others: how gender, race, and age influence pain expectations. J Pain 2012;13:220–7.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅