Pain and Mood Patterns in Patients with Rheumatoid Arthritis

Sixteen randomly selected patients, fulfilling the American Rheumatism Association criteria for definite or classic rheumatoid arthritis, were involved in a longitudinal psychosomatic study during their stay on a rheumatic diseases unit. After initial rheumatologic and psychiatric evaluation, twice daily mood and pain ratings were conducted by a single observer employing a mood adjective check list and a dolorimeter for measuring all upper limb peripheral joint tenderness. Twenty-one separate studies, each averaging 36 days, were carried out; 3 patients were studied on at least one other occasion. Two pain-mood patterns emerged: asynchronousstate, characterized by mood changes within an anxiety or hostility spectrum, either closely preceding or concomitant with fluctuations in joint tenderness; and aparadoxicalstate, characterized by an inverse relationship between intensity of joint tenderness and a sense of hopelessness. The patients' age, sex, social class, duration of illness, radiologic joint changes, functional disability and medication bore no relationship to these patterns. In a 1-2 year follow-up of the 2 groups of 8 patients each, the paradoxical group predictably demonstrated a less favorable outcome.