Background/Purpose: Several studies pay a particular attention to catastrophizing. Catastrophizing is a negative cognitive and affective response based on inadequate expression of pain. The objective was to assess catastrophizing level in rheumatoid arthritis (RA) and to determine if there is a link between catastrophizing and physical pain intensity, disease activity, disability, depression and quality of life.

Methods: We performed a systematic review of litterature and search the following databases : PUBMED-MEDLINE, COCHRANE and EMBASE until April 2018. All observationnal, cross-sectionnal and randomized control studies investigating catastrophizing in patients with rheumatoid arthritis were included. Statistical analysis defined pooled mean catastrophizing level, using the Pain Catastrophizing Scale (PCS) and assessed the association with disease activity (DAS28), pain (Numerical Rating Scale NRS) and quality of life (SF36).

Results: On 1494 articles concerning catastrophizing and rheumatic disorders, 22 articles concerned RA patients. Finally, 7 were selected in the meta-analysis including 601 RA patients (mean age 57.4 years old, 67.7% female, mean pooled DAS 28 = 3.4 and mean pooled VAS = 3.8). Mean pooled catastrophizing level at baseline was 14.7 (sd = 11.4) in RA patients. In one study, a RA sample identified 22% of high catastrophizers (defined by PCS > ou = 30). There is a significantly positive correlation between pain catastrophizing and disease activity in 3 studies (r between 0.22 and 0.39, all p<0.01) (Table). Pain is strongly associated with catastrophizing (r=0.71 (p<0.01) for NRS; r = -0.43 (p<0.01) for SF-36 Bodily Pain). Higher PCS scores were significantly associated with higher levels of distress i.e. lower SF-36 Mental Health score (r= -0.52 (p<0.01)). Moreover catastrophizing is significantly associated with reduced physical function (r=-0.35 (p<0.01) for SF36 Physical Function) (Table).

Conclusion: Catastrophizing is rarely measured but it’s a common psychological trait which is clearly associated with disease activity, pain, mental health and physical function. It would be interesting to early detect it in order to adapt pharmacologic and non-pharmacologic treatment.

Table 1 : Correlation coefficient between Pain Catastrophizing Scale(PCS) and variables of interest in RA patients

Results are expressed by correlation coefficient (r) and signifiance level (p)
* Numerical Rating Scale
° SF-36 Bodily Pain

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/catastrophizing-in-rheumatoid-arthritis/