The
Association between Social Network, Disease Activity, and Pain in Rheumatoid
Arthritis

Background/Purpose:
Current research suggests that high social network status is related to lower
levels of reported pain in rheumatoid arthritis patients (RA). The nature of
this relationship is not well known but may be related to disease activity.
This study aims to examine the relationship between social network, reported pain,
and disease activity.

Methods:
Data collected from a single-center, prospective observational RA cohort study,
including joint examinations, blood draws, and patient reported outcome
measures, were analyzed cross-sectionally. Subjects
completed the Berkman-Syme Social Network Index (SNI),
an ordinal scale ranging from 0 to 4 where 0 indicates no social network and 4
indicates high social network. Disease activity scores were calculated using
the DAS28-CRP3. Reported pain data were obtained from the pain scale in the
Multidimensional Health Assessment Questionnaire (MDHAQ); a continuous scale
ranging from 0 to 100 where 0 indicates no pain and 100 indicates severe pain. A
multivariable linear regression model was performed using a stepwise selection
approach to examine the association between social network, reported pain, and
disease activity. The variables initially entered into the model included age,
gender, social network, disease activity, disease duration, and seropositivity. Disease duration and seropositivity
were not significant, and thus were excluded from the final model.

Results:
1053 subjects with a mean age of 57.5 (SD13.6) years and a
mean disease duration of 13.8 (SD11.9) years were analyzed. In this
cohort, 83% were female and 69.7% were seropositive. On
average, DAS28-CRP3 score was 3.2 (SD1.5), SNI was 2.4 (SD1.0), and MDHAQ pain
score was 32.0 (SD26.2). Using a univariate analysis
it was found that age, disease duration, seropositivity,
disease activity, and SNI were associated with reported pain. In the final
multivariable linear regression model, SNI was significantly inversely associated
with reported pain (β coefficient -1.8, p=0.02), after controlling for
disease activity.

Conclusion:
High social network status was associated with lower reported pain, in this
cohort of RA patients, even after controlling for disease activity.  It is unclear if high social network status
has psychosocial benefits that lead to reduced pain, or if low pain promotes
patients’ social participation causing a high social network status. Future
studies are needed to further examine the relationship between social support
and reported pain, and if this association is present longitudinally.