Key points are not available for this paper at this time.
Background: Pain and fatigue are prominent in rheumatoid arthritis (RA) and often persist over time, even where inflammation is well-controlled by treatment1. While influenced by peripheral drivers (e.g. joint inflammation), these symptoms may also be sustained by non-inflammatory processes such as psychological and socioeconomic factors2. It is important not only to describe the trajectory of pain and fatigue after treatment, but also to understand which non-inflammatory factors are most associated with these changes. Objectives: We aim to describe trends in somatic symptoms (pain and fatigue) over 12 months in an RA cohort and identify associated factors. Methods: We used data from 225 RA patients starting or switching disease-modifying treatment recruited between 12/2018 and 9/2021. Somatic symptoms were measured at baseline, 3- and 12-months including ratings of pain and fatigue due to RA on a 0-100 visual analog scale (VAS), widespread pain index (WPI), and symptom severity score (SSS). Additional data collected included sociodemographics, clinical variables, and psychological factors (e.g. Patient Health Questionnaire (PHQ9), Generalized Anxiety Disorder (GAD7) questionnaire, and Cognitive and Behavioral Response to Symptoms (CBRQ) questionnaire). Longitudinal mixed-effects models estimated the association between somatic symptoms as outcomes and predictor variables over time. Multiple imputation accounted for missing baseline data. Results: Reported pain and fatigue VAS decreased significantly over 12 months but remained at clinically significant levels. WPI and SSS did not decrease significantly (Table 1). At baseline, somatic symptoms were significantly associated with education, disease severity, current symptoms of depression/anxiety, and certain coping behaviors, particularly all-or-nothing (i.e. doing things in bursts) and avoidance behaviors (Table 2). Persistent symptoms over time were also significantly associated with the above factors and additionally ethnicity and financial insecurity (Table 2). More severe disease activity was associated with higher pain VAS and WPI than with fatigue VAS and SSS. Higher levels of mental distress were consistently associated with all somatic symptom assessments. Conclusion: In this cohort of RA patients starting new disease-modifying treatments, pain and fatigue decreased but remained high over 12 months. Current RA treatments focus on suppressing inflammation, however, somatic symptoms were influenced by both inflammatory and non-inflammatory processes, which were largely psychological rather than contextual factors. Disease management should incorporate strategies that target mental health and coping behaviors. Table 1. Mean values of pain and fatigue outcomes assessed at baseline, 3-months, and 12-months. Table 2. Mixed effects model results (coefficients and confidence intervals). PREFERENCES: 1 McWilliams et al. Clin Exp Rheumatol 35.Suppl 107 (2017): 94-101. 2 Buch et al. Nature Reviews Rheumatology 17.1 (2021): 17-33. Acknowledgements: The authors would like to thank MQ and Versus Arthritis as the funders of this project, and the Wellcome Trust (ST12406) for funding to support L.Z.. Disclosure of Interests: Lucy Zhao: None declared, Colleen Sweeney: None declared, Lewis Carpenter Statistical consultancy for Pfizer., Savia de Souza: None declared, Emma Caton: None declared, James Galloway Has received honoraria from AbbVie Celgene, Chugai, Gillead, Janssen, Eli Lilly, Pfizer, Roche, and UCB., Andrew Cope: None declared, Kirsty Bannister: None declared, Elena Nikiphorou: None declared, Rona Moss-Morris: None declared, Sam Norton Has received honoraria from Janssen and Pfizer.
Zhao et al. (Sat,) studied this question.