How Much Does Pain Catastrophizing Affect Patients With RA, PsA, and axSpA?

Mature woman with painful hand.
Researchers analyzed pain catastrophizing in patients with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis from a biopsychosocial perspective.

Patients with axial spondyloarthritis (axSpA) reported significantly higher pain catastrophizing scores (PCS) compared with patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), according to research published in Rheumatology International.

For the cross-sectional study, researchers enrolled patients with inflammatory arthritis between 2018 and 2020 from an outpatient clinic in Norway. Patients (N=1229) underwent routine rheumatologic assessment for their disease, were evaluated for markers of inflammation, and responded to questionnaires about patient reported outcome (PRO), which covered aspects of the biopsychosocial domains. Low pain catastrophizers were defined as PCS lower than 4 and high catastrophizers as PCS greater than or equal to 4.

The RA, PsA, and axSpA cohorts had a mean age of 61.5 (95% CI, 60.4-62.5), 54.4 (95% CI, 53.1-55.7), and 47.5 (95% CI, 46.0-49.1) years (P <.01); 66.7%, 47%, and 38.4% were women (P <.01); and BMI was 26.4 (95% CI, 26.0-26.8), 28.0 (95% CI, 27.5-28.6), and 27.1 (95% CI, 26.5-27.7) (P <.01), respectively.

Mean PCS was 1.88 (standard deviation [SD], 1.39) for RA, 2.06 (SD, 1.45) for PsA, and 2.27 (SD, 1.37) for axSpA. PCS values differed significantly between the axSpA cohort and RA (P <.001) and PsA (P =.044) groups. The proportion of patients who were high catastrophizers was 10.5% for RA, 12.7% for PsA, and 15.3% for axSpA, which was trending toward significance between axSpA and RA (P =.05).

Patients who were high catastrophizers reported significantly lower health-related quality of life (HRQoL). Stratified by catastrophizing status, the high catastrophizers reported lower RAND12 values among the RA (mean absolute difference, 20.9 vs 34.1), PsA (mean absolute difference, 9.1 vs 46.2), and axSpA (mean absolute difference, 15.8 vs 42.6) cohorts.

Among the RA cohort, PCS was associated with 19 aspects of the biopsychosocial domains. The PsA and axSpA cohorts had 21 and 15 associated variables.

In a multivariate analysis, the PROs accounted for 56.6% of the variance of PCS for the RA cohort, 46.9% of the variance for the PsA cohort, and 43.5% of the variance for the axSpA group. Stratified by domain, the subjective biological domain accounted for 35.3% to 49.9%, the psychological domain 28.4% to 33.6%, the social domain 22.4% to 28.4%, and the objective biological domain 4.3% to 9.9% of the variance in PCS.

The study was limited by not including a healthy control cohort. It remains unclear how PROs and HRQoL compare to the general population.

The study data indicated that patients with axSpA had higher PCS than RA or PsA patients. Among all patient cohorts, PCS was observed to be associated with 4 biopsychosocial domains and was most strongly associated with aspects in the biological subjective domain.

“High PCS across all diagnoses was best explained by the biological subjective domain and was associated with impaired HRQoL,” the study authors noted. “Several measures within all domains were found to be independently associated with high PCS, which might suggest a specific phenotype of patients prone to pain catastrophizing.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Wilk M, Łosińska K, Pripp AH, Korkosz M, Haugeberg G. Pain catastrophizing in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: biopsychosocial perspective and impact on health‑related quality of lifeRheumatol Int. Published online January 31, 2022. doi:10.1007/s00296-021-05070-4