Pos0307 Central Sensitivity Syndrome Affects the Treatment Satisfaction in Patients With Rheumatoid Arthritis

Background: Many patients with RA consider improvement in pain the priority in treatment. However, pain has multiple causes, not just inflammatory. Central sensitivity syndromes (CSS) is one of the causes of pain in RA; therefore, we hypothesised that CSS may also influence satisfaction with treatment in patients with RA. To our knowledge, the effect of CSS-related pain on satisfaction with treatment has not been reported for patients with RA. We believe that improving patients' satisfaction is important because higher satisfaction with treatment is associated with improved compliance and persistence with treatment, as well as with reduced regimen complexity and treatment burden[1]. Objectives: In this cross-sectional study, we evaluated the effects of central sensitivity syndrome (CSS) in patients with rheumatoid arthritis (RA) on the assessment of clinical disease activity and satisfaction with treatment. Methods: Participants were 240 consecutive patients with RA (61 men and 179 women; mean age, 70.1 ± 11.9 years; mean disease duration, 13.3 ± 10.6 years) who were receiving long-term follow-up. All patients were evaluated for clinical disease activity and satisfaction with treatment. CSS was evaluated with the Central Sensitization Inventory (CSI) [2]. An overall score ≥40 indicates the presence of CSS and an overall score from 30 to 39 indicates the presence of mild CSS. And we asked, 'How satisfied are you with your treatment?'; answers were (a) very satisfied, (b) satisfied, (c) not satisfied or (d) very dissatisfied. For univariable analysis, we condensed the four answers into two: 'dissatisfied' or 'satisfied' [3]. We also evaluated satisfaction with treatment by using the VAS, for which scores could range from 0 mm (very dissatisfied) to 100 mm (very satisfied). Results: Of the 240 patients, 20 (8.3%) were classified as having CSS, 22 patients (9.1%) as having mild CSS. CSI score was significantly correlated with clinical disease activity index scores (CDAI) (r=0.305, p<0.01), patient satisfaction with treatment(r=-0.278, p<0.01). With regard to patients' satisfaction with treatment, univariable analysis showed that PtGA, pain VAS, HAQ-DI, DAS28 CRP, CDAI and CSI score of patients who were satisfied with treatment significantly differed from those of dissatisfied patients. Multivariable analysis revealed that CSI score, PtGA and HAQ-DI scores were associated with patient satisfaction (Table 1). Cut-off points determined by receiver operating characteristic analysis indicated that CSI scores of ≥30 were also associated with patient dissatisfaction, with 70.0% sensitivity and 88.2% specificity. Table 1. Independent factor of patient satisfaction determined using univariable and multivariable logistic regression analysis. Conclusion: In patients with RA, CSS may affect the disease activity index and reduce patients' satisfaction with treatment. REFERENCES: [1] Barbosa CD, et al. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence. 2012; 6: 39–48. [2] Mahlich J, et al. Shared Decision-Making and Patient Satisfaction in Japanese Rheumatoid Arthritis Patients: A New "Preference Fit" Framework for Treatment Assessment. Rheumatol Ther. 2019; 6(2): 269-283. [3] Mayer TG, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012; 12(4): 276-285. Acknowledgements: We thank the staffs (Ms. Mayumi Tanabe and Yukari Jo) at Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, for their assistance with this study. Disclosure of Interests: None declared.