#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Perception of pain in men and women with rheumatoid arthritis


Authors: I. Nagyová 1;  K. Thorstensen 1;  J. Benka 2;  Ž. Macejová 3
Authors place of work: Ústav sociálnej a behaviorálnej medicíny, Lekárska fakulta, Univerzita P. J. Šafárika, Košice 1;  Katedra pedagogickej psychológie a psychológie zdravia, Filozofická fakulta, Univerzita P. J. Šafárika, Košice 2;  I. interná klinika, Lekárska fakulta, Univerzita P. J. Šafárika a Univerzitná nemocnica L. Pasteura, Košice 3
Published in the journal: Čes. Revmatol., 27, 2019, No. 3, p. 106-114.
Category: Original article

Summary

Objective: Epidemiologic, clinical, and experimental evidence points to gender differences in musculoskeletal pain. However, less is known about the factors that play a role in these differences. The aim of our study was to analyse the relative proportion of sociodemographic, clinical, and psychological characteristics explaining differences in perception of pain in men and women with rheumatoid arthritis (RA).

Sample and methods: The sample consisted of 297 patients with RA (240 women and 57 men) with mean age of 56.0 ± 11.6 years and mean disease duration of 10.3 ± 6.9 years. Pain was assessed using two standardized scales – the Ritche Articular Index (RAI) and the pain subscale of the Short Form-36 Health Survey (SF36-BP). The disease activity was measured by examining the CRP levels, FW values, and DAS28-CRP4. Disability was assessed by the Health Assessment Questionnaire (HAQ-DI), anxiety and depression using the General Health Questionnaire (GHQ-28), and adjustment to disease by a single-item scale ADJ.

Results: Multiple regression analyses showed that men and women differ in perception of pain. In males, significant factors associated with pain were clinical parameters explaining 40% and 22% of the total variance in pain (RAI: Fsmc = 7.189, p < 0.001; SF36-BP: Fsmc = 5.187, p < 0.001). In females, also psychological characteristics played a significant role in subjective perception of pain, adding up to 9% to the total explained variance (SF36-BP: Fsmc = 8.107, p < 0.001), after controlling for relevant sociodemographic and clinical characteristics.

Conclusions: The results of this study suggest that psychological distress and especially pain-related anxiety is part of the reason why men and women might perceive pain differently. A better understanding of the mechanisms that lead to persistent chronic pain and accounting for gender differences may increase the overall effectiveness of treatment in RA patients.

Keywords:

rheumatoid arthritis – Pain – gender differences – anxiety – depression – disease activity


Zdroje

1. Burmester GR, Pratt AG, Scherer HU, van Laar JM. Rheumatoid arthritis: pathogenesis and clinical features. In: Bijlsma JWJ (ed.) EULAR textbook on rheumatic diseases. London: BMJ Group 2012; 206–231.

2. Macejova Z, Rybar I. Farmakoterapia reumatoidnej artritídy I – nesteroidové antireumatiká, DMARDs. Via pract 2010; 7(1): 30–33.

3. Rovenský J. Reumatoidná artritída – klinický klinický obraz, diagnostika a liečba. Via pract 2008; 5(1): 6–13.

4. Scott DL, Smith C, Kingsley G. What are the consequences of early rheumatoid arthritis for the individual. Best Pract Res Clin Rheumatol 2005; 19: 117–136.

5. Kvien T K, Uhlig T, Odegard S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann N Y Acad Sci 2006; 1069: 212–222.

6. Sokka T, Soloza S, Cutolo M, et al. Women, men, and rheumatoid arthritis: analyses of disease characteristics, and treatment in the QUEST-RA study. Arthritis Res Ther 2009; 11(1): R7.

7. Ahlmen M, Svensson B, Albertsson K, Forslind K, et al. Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis 2010; 69(1): 230–233.

8. Kekow M, Barleben M, Drynda S, Jakubiczka S, et al. Long-term persistence and effects of fetal microchimerisms on disease onset and status in a cohort of women with rheumatoid arthritis and systemic lupus erythematosus. BMC Musculoskelet Disord 2013; 14: 325.

9. IASP – International Association for the Study of Pain. Merskey H, et al. Pain Terms: A list with definitions and notes on usage. Recommended by an IASP Subcommittee on Taxonomy. Pain 1979; 6: 249–252.

10. Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther 2011; 13(2): 211.

11. Riley JL 3rd, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998; 74(2–3): 181–187.

12. Defrin R, Shramm L, Eli I. Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold. Pain 2009; 145(1–2): 230–236.

13. Gijsbers K, Nicholson F. Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills 2005; 101(3): 803–807.

14. Macejová Ž, Kovářová M, Nagyova I, Spišák B, Szilasiová A. Bolesť a reumatoidná artritída. Vnitř. Lék. 1999; 45(6): 359–363.

15. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–324.

16. Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968; 147: 393–340.

17. Ware JE Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–483.

18. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol 2005; 23(5 Suppl 39): S14–18.

19. Wolfe F, Kleinheksel SM, Cathey MA, Hawley DJ, Spitz PW, Fries JF. The clinical value of the Stanford Health Assessment Questionnaire Functional Disability Index in patients with rheumatoid arthritis. J Rheumatol 1988; 15: 1480–1488.

20. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9: 159–163.

21. Briancon S, Doeglas D, Guillemin F, van den Heuvel W, Krol B, Sanderman R, et al. EURIDISS: European Research on Incapacitating Diseases and Social Support. Int J Health Sci 1990; 1: 217–228.

22. Alvaro JL, Garrido A, Pereira CR, Torres AR, Barros SC. Unemployment, self–esteem, and depression: differences between men and women. Span J Psychol 2019; 28(22): e1, 1–9.

23. Artazcoz L, Benach J, Borrel C, Cortes I. Unemployment and mental health: Understanding the interactions among gender, family roles and social class. Am J Public Health 2004; 94(1): 82–88.

24. Mehlum IS, Kristensen P, Kjuus H, Wergeland E. Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain? Scand J Work Environ Health 2008; 34(4): 250–259.

25. Kunst A, Bos V, Mackenbach J. EU Working Group on Socioeconomic Inequalities in Health. Monitoring socio–economic inequalities in health in the European Union: guidelines and illustrations: a report for the Health Monitoring Program of the European Commission. Rotterdam (Netherlands): Department of Public Health, Erasmus University 2001.

26. Atzeni F, Masala IF, Salaffi F, Di Franco M, Casale R, Sarzi-Puttini P. Pain in systemic inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2015; 29(1): 42–52.

27. Odegard S, Finset A, Mowinckel P, et al. Pain and psychological health status over a 10–year period in patients with recent onset rheumatoid arthritis. Ann Rheum Dis 2007; 66: 1195e201.

28. Sokka T, Kankainen A, Hannonen P. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 2000; 43(2): 386–389.

29. Edwards RR, Ness TJ, Weigent DA, Fillingim RB. Individual differences in diffuse noxious inhibitory controls (DNIC): association with clinical variables. Pain 2003; 106(3): 427–437.

30. Elklit A, Jones A. The association between anxiety and chronic pain after whiplash injury: gender–specific effects. Clin J Pain 2006; 22(5): 487–490.

31. Jones A, Zachariae R, Arendt–Nielsen L. Dispositional anxiety and the experience of pain: gender-specific effects. Eur J Pain 2003; 7(5): 387–395.

32. Beebe M, Utley R. Primary Care Depression Screening: Relationship to Chronic Pain and Gender. The Journal for Nurse Practitioners 2018; 1: e13–16.

33. Keogh E, McCracken LM, Eccleston C. Do men and women differ in their response to interdisciplinary chronic pain management? Pain 2005; 114(1–2): 37–46.

34. Moore DJ, Eccleston C, Keogh E. Does sex moderate the relationship between anxiety and pain? Psychol Health 2013; 28(7): 746–764.

35. Keogh E, Denford S. Sex differences in perceptions of pain coping strategy usage. Eur J Pain 2009; 13(6): 629–634.

36. Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of chronic pain: domains, methods, and mechanisms. J Pain 2016; 17(9 Suppl): T10–20.

37. Goldenberg DL. The interface of pain and mood disturbances in the rheumatic diseases. Semin Arthritis Rheum 2010; 40(1): 15–31.

38. Provan SA, Austad C, Halsaa V, Hammer HB, Kvien TK, Uhlig T. Fibromyalgia in patients with rheumatoid arthritis. A 10-year follow-up study, results from the Oslo Rheumatoid Arthritis Register. Clin Exp Rheumatol 2019; 37(Suppl 116(1)): 58–62.

Štítky
Dermatology & STDs Paediatric rheumatology Rheumatology
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#