Pain Catastrophizing Decreases in Rheumatoid Arthritis After DMARD Initiation

hand arthritis
hand arthritis
Pain catastrophizing decreases over time in patients with RA who respond to DMARD treatment.

When patients with rheumatoid arthritis (RA) initiate a new disease-modifying antirheumatic drug (DMARD), pain catastrophizing decreases over time as disease activity decreases, according to results published in the Journal of Clinical Rheumatology.

The results indicate that catastrophizing is a dynamic construct and can be reduced by treatment that decreases inflammatory disease activity and pain.

The study included participants with RA who initiated a new DMARD (n=165). Participants completed the Pain Catastrophizing Scale (PCS) before and 12 weeks after DMARD initiation. The researchers used multivariable linear regression models to determine whether there was an association between changes in the Clinical Disease Activity Index (CDAI) and pain catastrophizing. They also assessed the relationship between changes in CDAI and changes in PCS.

After 12 weeks, CDAI decreased from 22 to 11.5 on a 76-point scale (P <.0001), pain intensity decreased from a median of 5 to 3 on a 10-point scale (P <.0001), and catastrophizing decreased from 16.0 to 12.0 on the 52-point PCS scale (P =.0005).

The researchers found that changes in CDAI were positively correlated with changes in catastrophizing (standardized β=0.19; P =.01). The component of the CDAI that had the strongest association with changes in catastrophizing was assessor global score (standardized β=0.24; P =.003).

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“These findings suggest that effective management of disease activity, particularly as it relates to joint tenderness, may be useful in reducing pain catastrophizing, with [a] resultant impact on psychological processes and patient perception,” the researchers wrote.

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Cohen EM, Edwards RR, Bingham CO, et al. Pain and catastrophizing in patients with rheumatoid arthritis: a prospective observational cohort study [published online June 22, 2018]. J Clin Rheumatol. doi:10.1097/RHU.0000000000000834