Food insecurity and pain burden in patients with multiple sclerosis and rheumatoid arthritis: A comparative case-control study

Background Food insecurity (FI) is strongly associated with chronic disease diagnoses, pain, and functional decline. Patients with multiple sclerosis (MS) and rheumatoid arthritis (RA) have been reported to experience some degree of FI. Aims To assess and compare the prevalence of FI in patients with MS and RA and examine associations between FI, disease severity, disability, and pain. Methods A comparative case-control design was adopted, including 40 patients with MS and 40 patients with RA. FI was assessed using the Household Food Insecurity Access Scale (HFIAS), and pain was evaluated using the Brief Pain Inventory (BPI). Disease severity was measured using the Expanded Disability Status Scale (EDSS) for MS and the Disease Activity Score in 28 joints (DAS28) for RA. Group comparisons were performed, and multivariable regression analyses were conducted to examine associations between FI, pain, disease activity, and demographic factors. Summary FI was identified in 65% of patients with MS and 37.5% of those with RA ( p = 0.014). Patients with MS had greater odds of exhibiting FI compared to those with RA ( p = 0.028). In multivariable analyses among patients with MS, greater disability was associated with increased FI ( p = 0.019). In contrast, among those with RA, disease activity was not associated with FI. In pooled sample analyses, greater FI was independently associated with both pain severity ( p = 0.027) and pain interference ( p = 0.009). Overall, FI is prevalent among patients with MS and RA, with a greater prevalence observed in MS. Greater FI was consistently associated with increased pain severity and interference. These findings highlight the importance of routine FI screening and tailored nutritional and social support interventions in vulnerable populations.