Types of Pain and Its Psychosocial Impact in Women with Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease that primarily affects middle-aged women. Very commonly, pain is a symptom of active disease, and since untreated RA can lead to joint deformities, current pain assessments focus primarily on inflammation. Furthermore, treatment is predicated on reducing disease activity in the hopes of stopping worsening damage, preventing future deformities, and ultimately providing pain relief to patients. However, studies show that all patients with rheumatoid arthritis, especially women, often suffer from anxiety, depression, sleep disturbances, sexual dysfunction, and disability, in addition to increased mechanical pain and fibromyalgia, which increase the burden of the disease.
Chancay, MG, Guendsechadze, SN & Blanco, I. Types of pain and their psychosocial impact in women with rheumatoid arthritis. Women's Midlife Health 5, 3 (2019). https://doi.org/10.1186/s40695-019-0047-4
Commentary
Having a chronic disease such as RA has been shown to increase the risk of developing "mood" or "anxiety" disorders. This is similar to hypertension and diabetes, and the risk is said to be increased especially among women. Also, as with sleep disorders, there is a bidirectional link between RA and depression, so we know that depression increases pain sensitivity, which in turn increases the pain associated with RA. Second, it has been shown that more than half of RA patients may experience some degree of sexual dysfunction. This is multifactorial, including psychosocial complications, but the limitation of physical activity due to RA makes it difficult to engage in sexual activity. In addition, they also experience changes in appearance and function. Women with the famous morning stiffness have been shown to be more concerned with their body image and report more sexual dissatisfaction [. And women who experienced weight gain also reported poor perceptions of their bodies. These have led to decreased sexual desire, fear of pain, and fear of not being able to engage in satisfying sexual relationships.
And it interferes with daily life, with nearly 85% of patients reporting difficulty with household chores.
These negative effects are assessed with the Health Assessment Questionnaire (HAQ), and worsening HAQ scores are also associated with lower quality of life and negative effects on relationships. The loss of function and disability experienced by patients with rheumatoid arthritis may exacerbate depression and sleep disturbances, and contribute to social isolation and worsening pain perception.
