What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatoid arthritis (n=209). Intervention: DMARD treatment change or dose escalation. Primary outcome: Pain VAS rating (0-100) at 12 months (95% CI 43.1-48.6).

What question did this study set out to answer?

The study aims to explore the psychosocial and behavioral factors contributing to persistent pain in rheumatoid arthritis (RA) after treatment change.

April 3, 2026Open Access

Psychosocial and behavioral correlates of persistent pain post disease-modifying treatment change in rheumatoid arthritis: a 12-month cohort study

Key Result

Rheumatoid arthritis patients undergoing DMARD changes experienced persistent pain over 12 months (mean VAS 45.9), with higher pain significantly linked to lower education and financial stress.

Key Points

The study aims to explore the psychosocial and behavioral factors contributing to persistent pain in rheumatoid arthritis (RA) after treatment change.
Assessed pain trends in RA patients over 12 months post-treatment change via PROsPer-RA cohort.
Collected clinical and patient-reported outcomes at baseline, 3 months, and 12 months including pain and psychological factors.
Employed latent growth curve models to analyze associations between various predictors and pain outcomes.
Conducted mediation analyses to explore if cognitive and behavioral responses influenced the pain-depression/anxiety relationship.
Persistent pain levels remained moderate-to-high over 12 months despite treatment adjustments.
Baseline joint pain averaged 49.8 out of 100, with widespread pain index (WPI) averaging 4.9 out of 17 areas.
Higher baseline pain correlated with male gender, financial stress, lower education, and unemployment.
Worse depression and anxiety symptoms were linked to higher pain outcomes at baseline and over time.
Fear-based behavioral responses mediated the relationship between depression/anxiety and pain outcomes.

Study Design

Type

Cohort (n=209)

Multicenter

Yes

Structured PICO

Do psychosocial and behavioral factors correlate with persistent pain in rheumatoid arthritis patients undergoing DMARD treatment changes?

Population

Adults (aged ≥16 years) with confirmed rheumatoid arthritis (RA) switching or escalating disease-modifying anti-rheumatic drug (DMARD) treatment, mean age 53.2, 73.2% female

Intervention

Switching or escalating disease-modifying anti-rheumatic drug (DMARD) treatment

Outcome

Pain trends over 12 months, assessed via joint pain (visual analog scale) and widespread pain index (WPI)patient reported

Pain symptoms in rheumatoid arthritis persist at moderate-to-high levels over 12 months despite DMARD changes, driven significantly by psychological distress and fear-avoidance behaviors.

Limitations

Approximately 20% missing data at baseline due to data collection challenges during the COVID-19 pandemic
The recruited RA cohort was clinically more selective than the general RA population
Absence of validated anchor-based minimal clinically important differences (MCIDs) reported for WPI in RA patients

Abstract

Pain is a debilitating and persistent symptom of rheumatoid arthritis (RA), associated with impaired functional capacity and reduced quality of life. Despite targeted disease-modifying treatments, many RA patients experience persistent pain, suggesting mechanisms operating independently of classic inflammatory pathways. Psychological factors, such as depression and anxiety, can impact patterns of appraisal and behavioral coping strategies. Understanding how these associations underpin pain symptoms in RA is key for developing targeted symptom management interventions. Using data from the Patient-Reported Outcomes in patients with Persistent Rheumatoid Arthritis (PROsPer-RA) cohort, pain trends were assessed over 12 months following disease-modifying adjustment, mapping these against socioeconomic, psychological, and behavioral factors to identify associations and mechanisms. This prospective study followed RA patients recruited to PROsPer-RA switching or escalating disease-modifying treatment. Clinical and patient-reported outcomes were collected at baseline, 3, and 12 months, including disease activity, joint pain (visual analog scale), widespread pain index (WPI), depression and anxiety symptoms, and cognitive and behavioral responses to symptoms. Latent growth curve models estimated associations between predictor variables and pain outcomes at baseline and over time. Mediation analyses examined whether cognitive and behavioral responses mediated the relationship between depression/anxiety symptoms and pain outcomes. Among 209 eligible patients, baseline joint pain was 49. 8\: \: 24. 9 out of 100 (worst pain) and WPI was 4. 9\: \: 3. 6 out of 17 areas, which persisted at similar levels at 3 and 12 months. Higher baseline pain was associated with male gender, financial stress, lower education, and unemployment. Higher levels in both pain outcomes associated with worse depression and anxiety symptoms at baseline and over time. Avoidance-based behavioral responses, particularly fear avoidance, were associated with worse pain and mediated the relationship between depression/anxiety symptoms and both pain outcomes. In this RA cohort, pain symptoms persisted at moderate-to-high levels over 12 months despite changing disease-modifying treatments. These symptoms were driven by psychological and behavioral factors alongside socioeconomic factors. Current RA therapies may be insufficient without considering the non-inflammatory processes driving persistent pain. Disease management should incorporate strategies that target mental health as well as cognitive and behavioral response patterns to symptoms.

Mark Helpful

Bookmark

Relay

View Full Paper