Higher pain intensity is associated with less resilience in patients with rheumatoid arthritis

Husein, Raida Ahmad Musa Mheisen; Rhoden, Deise Juliana; Nunes, Paula Lorenzoni; Kleibert, Karine Raquel Uhdich; Stumm, Eniva Miladi; Colet, Christiane de Fatima

doi:10.5935/2595-0118.20230065-en

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ORIGINAL ARTICLE • BrJP 6 (3) • Jul-Sep 2023 • https://doi.org/10.5935/2595-0118.20230065-en copy

Higher pain intensity is associated with less resilience in patients with rheumatoid arthritis

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

People who were more resilient had less pain.
Less resilient patients had more painful joints.
Resilience can help the clinical outcome of the disease.

ABSTRACT

BACKGROUND AND OBJECTIVES:

Rheumatoid arthritis is an inflammatory, chronic and autoimmune disease that causes joint damage and can lead to physical disability. Patients with chronic and debilitating diseases such as arthritis need to adapt to the new reality. These changes may have less impact on patients with greater self-efficacy and resilience. Psychosocial factors influence the quality of life (QoL) of these patients, so the aim of this study was to assess resilience in this population and its relationship with pain, functional capacity and disease activity.

METHODS:

This is a cross-sectional study carried out with patients at a medical specialties clinic, using a sociodemographic, a clinical-laboratory, a health assessment, a disease activity score questionnaires and the Wagnild and Young Resilience Scale. The data was analyzed using Fisher’s Exact, Chi-square, Student’s t and ANOVA tests.

RESULTS:

120 patients participated in the study, 89.2% female, mean age 56.9 ± 10.7 years. Pain was classified as severe by 40.8%, 65.8% had disease in remission and 50.8% had mild disability. The resilience of 49.2% was high. There was an association between lower resilience and: presence of painful joints (p=0.004) and greater pain intensity (p=0.014). There was a lower average of resilience (130.95) in participants with severe disability.

CONCLUSION:

Patients with less resilient rheumatoid arthritis had greater functional disability, painful joints and greater pain intensity. In addition, from the moment additional measures are adopted, such as educational actions and behavioral strategies, with an emphasis on resilience, which help in the control and clinical outcome of the disease, there will certainly be a positive impact on the quality of life of these patients.

Keywords
Health systems; Musculoskeletal pain; Pain; Psychological resilience; Rheumatoid arthritis

Sociodemographic variables		≥ 147	< 147	Total	p-value
Gender	Male	7 (5.8)	6 (5.0)	13 (10.8)	0.978
Gender	Female	52 (43.3)	55 (45.8)	107 (89.2)	0.978
Age	Under 60 years old	34 (28.3)	35 (29.2)	69 (57.5)	0.721
Age	60 years or older	25 (20.8)	26 (21.7)	51 (42.5)	0.721
Marital status	With partner	35 (29.2)	47 (39.2)	82 (68.3)	0.037^* * significant for p<0.05.
Marital status	No partner	24 (20.0)	14 (11.7)	38 (31.7)	0.037^* * significant for p<0.05.
Education	Up to elementary school	41 (34.2)	53 (44.2)	94 (78.3)	0.021^* * significant for p<0.05.
Education	High school or above	18 (15.0)	8 (6.7)	26 (21.7)	0.021^* * significant for p<0.05.
Income	Up to 1 minimum wage	21 (17.5)	36 (30.0)	57 (47.5)	0.010^* * significant for p<0.05.
Income	More than 1 minimum wage	38 (31.7)	25 (20.8)	63 (52.5)	0.010^* * significant for p<0.05.
Smoking	Yes	15 (12.5)	26 (21.7)	41 (34.2)	0.047^* * significant for p<0.05.
Smoking	No	44 (36.7)	35 (29.2)	79 (65.8)	0.047^* * significant for p<0.05.
Profession	Housekeeping/cleaning	24 (20.0)	38 (31.7)	62 (51.7)	0.029^* * significant for p<0.05.
	Work in agriculture	14 (11.7)	14 (11.7)	28 (23.3)
	Self-employed	14 (11.7)	4 (3.3)	18 (15.0)
	Other	7 (5.8)	5 (4.2)	12 (10.0)
Type of query	SUS	41 (34.2)	53 (44.2)	94 (78.3)	0.021^* * significant for p<0.05.
Type of query	Other health plans	18 (15.0)	8 (6.7)	26 (21.7)	0.021^* * significant for p<0.05.
Total		59 (49.2)	61 (50.8)	120 (100)

Clinical features		Resilience
Clinical features		≥ 147	< 147	Total	p-value
Disease-related variables
Symptoms duration	Up to 5 years	30 (25.0)	30 (25.0)	60 (50.0)	0.855
Symptoms duration	More than 5 years	29 (24.2)	31 (25.8)	60 (50.0)	0.855
Time after diagnosis	Up to 5 years	38 (31.7)	38 (31.7)	76 (63.3)	0.810
Time after diagnosis	More than 5 years	21 (17.5)	23 (19.2)	44 (36.7)	0.810
Comorbidities	Yes	30 (25.0)	37 (30.8)	67 (55.8)	0.279
Comorbidities	No	29 (24.2)	24 (20.0)	53 (44.2)	0.279
Pain-related variables
Painful joints	Yes	14 (11.7)	30 (25.0)	44 (36.7)	0.004^* * significant for p<0.05. HAQ = Health Assessment Questionnaire; VAS = Visual Analog Scale; DAS 28 = Disease Activity Score; anti-CCP = anti-cyclic citrullinated peptide; CRP = C-reactive protein.
Painful joints	No	45 (37.5)	31 (25.8)	76 (63.3)
Swollen joints	Yes	8 (6.7)	15 (12.5)	23 (19.2)	0.125
Swollen joints	No	51 (42.5)	46 (38.3)	97 (80.8)	0.125
HAQ	Mild	40 (33.6)	21 (17.5)	61 (50.8)	<0.001^* * significant for p<0.05. HAQ = Health Assessment Questionnaire; VAS = Visual Analog Scale; DAS 28 = Disease Activity Score; anti-CCP = anti-cyclic citrullinated peptide; CRP = C-reactive protein.
	Moderate	15 (12.6)	23 (19.2)	38 (31.7)
	Severe	4 (3.3)	17 (14.2)	21 (17.5)
VAS	Painless/Mild	26 (21.7)	14 (11.7)	40 (33.3)	0.014^* * significant for p<0.05. HAQ = Health Assessment Questionnaire; VAS = Visual Analog Scale; DAS 28 = Disease Activity Score; anti-CCP = anti-cyclic citrullinated peptide; CRP = C-reactive protein.
VAS	Moderate/intense pain	33 (27.5)	47 (39.2)	80 (66.7)
DAS 28	Remission	44 (36.7)	35 (29.2)	79 (65.8)	0.220
	Mild	5 (4.2)	6 (5.0)	11 (9.2)
	Moderate	7 (5.8)	14 (11.7)	21 (17.5)
	Severe	3 (2.5)	6 (5.0)	9 (7.5)
Laboratory data
CRP	Reactive	10 (8.3)	8 (6.7)	18 (15.0)	0.556
CRP	Non-reactive	49 (40.8)	53 (44.2)	102 (85.0)	0.556
Rheumatoid factor	Positive	23 (19.2)	24 (20.0)	47 (39.2)	0.968
Rheumatoid factor	Negative	36 (30.0)	37 (30.8)	73 (60.8)	0.968
Anti-CCP	Positive	16 (13.3)	23 (19.2)	39 (32.5)	0.216
Anti-CCP	Negative	43 (35.8)	38 (31.7)	81 (67.5)	0.216
Total		59 (49.2)	61 (50.8)	120 (100)

Clinical parameters		Resilience
Clinical parameters		n	LL	UL	Mean	SD	CV
HAQ	Mild	61	116	175	148.90a	13.24	0.000^* * ANOVA p<0.05 statistically significant; means followed by the same letter do not differ statistically by Tukey’s test with 5% probability. n = number of patients; LL = lower limit; UL = upper limit; SD = standard deviation; CV = coefficient of variation; HAQ = Health Assessment Questionnaire; VAS = Visual Analog Scale; DAS 28 = Disease Activity Score.
	Moderate	38	104	169	142.00a	14.51
	Severe	21	89	156	130.95b	18.13
VAS	Painless	14	129	171	151.43	11.47	0.110
	Mild	26	116	169	146.46	13.85
	Moderate	31	89	163	140.81	14.54
	Severe	49	96	175	141.55	18.08
DAS 28	Remission	79	89	175	144.56	16.51	0.679
	Mild	11	110	169	143.73	20.75
	Moderate	21	120	161	142.14	11.28
	Severe	9	118	162	138.11	13.90
Total		120	89	175	143.57	15.89

Therapeutic features		Resilience
Therapeutic features		≥ 147	< 147	Total	p-value
Number of drugs	5 or less	32 (26.7)	31 (25.8)	63 (52.5)	0.708^&
Number of drugs	More than 5	27 (22.5)	30 (25.0)	57 (47.5)	0.708^&
Use of antidepressants			18 (15.0)	28 (23.3)	46 (38.3)
Type of treatment
DEMARDcs	Methotrexate	36 (30.0)	35 (29.2)	71 (59.2)	0.685^&
	Leflunomide	8 (6.7)	6 (5.0)	14 (11.7)	0.525^&
	Hydroxychloroquine	1(0.8)	5 (4.2)	6 (5.0)	0.111^# # Fisher’s Exact test;
	Combination therapy	14 (11.7)	15 (12.5)	29 (24.2)	0.912^&
DEMARDbio		9 (7.5)	11 (9.1)	20 (16.7)	0.683^&

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