SITE-SPECIFIC ASSOCIATIONS OF DISEASE ACTIVITY, PSYCHOLOGICAL DISTRESS, AND PRESSURE PAIN THRESHOLDS IN MALE PATIENTS WITH RHEUMATOID ARTHRITIS
Keywords:
Rheumatoid arthritis, pressure pain threshold, pain sensitivity, DAS28, depression, psychological distress, algometry, male patientsAbstract
Pain in rheumatoid arthritis (RA) is not always explained by synovitis alone. Patient-reported disease burden and psychological distress may also influence pain sensitivity. Pressure pain threshold (PPT) testing is a practical method for assessing pain sensitivity at articular and non-articular sites. Objective to examine the relationship between disease activity parameters, psychological distress, and PPTs in male patients with RA. This cross-sectional study included 50 consecutive male patients with RA who fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria. Patients with fibromyalgia and other conditions known to affect pain thresholds were excluded. PPTs were measured bilaterally at the thumbnail, wrist, and trapezius muscle using a pressure algometer. Disease activity was assessed using DAS28-ESR, and the patient-reported component of DAS28 was calculated as DAS28-P. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. Correlation analyses and multivariable linear regression models adjusted for age and disease duration were performed. Lower PPTs were significantly associated with higher tender and swollen joint counts, patient global assessment, ESR, DAS28-ESR, DAS28-P, and anxiety and depression scores. In multivariable analysis, ESR was independently associated with lower wrist PPT (beta = -0.34, P = 0.014). At the trapezius muscle, lower PPT was independently associated with higher depression scores (beta = -0.36, P = 0.018) and DAS28-P (beta = -0.28, P = 0.044). In male patients with RA, pain sensitivity appears to reflect both inflammatory and non-inflammatory influences. ESR was mainly associated with pain sensitivity at the wrist, whereas depression and patient-reported disease impact were associated with pain sensitivity at a non-articular site. These findings support a broader approach to pain assessment in RA that includes inflammatory activity, patient-reported disease burden, and psychological distress.
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