Illness perception, coping styles impact hand osteoarthritis pain over time
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Key takeaways:
- Worse pain was linked with lower disease understanding and coping with “comforting cognitions.”
- 38% of patients with hand OA had improved pain, 30% deteriorated and 32% remained stable across 4 years.
Patients’ perception of their illness and coping styles may play a role in whether hand osteoarthritis pain improves or deteriorates over the long term, according to data published in Arthritis Care & Research.
“Little is known about the course of hand OA pain over time and what determines this course,” Coen van der Meulen, MD, of Leiden University Medical Center, in the Netherlands, and colleagues wrote.
“Change in pain has been associated with change in synovitis measured on MRI, but not with radiographic signs,” they added. “It is currently unknown whether other mechanisms and risk factors that contribute to the occurrence of pain also influence the course of pain.”
To examine changes in hand OA pain over mid- and long-term periods among individual patients, as well as to characterize, and eventually predict, which patients experience improving or worsening pain, van der Meulen and colleagues analyzed data from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort. In all, the current study included data from 356 patients with hand OA (mean age, 60.6 years; 83% women).
The primary outcome was change in pain, assessed via the pain subscale of the Australian/Canadian hand osteoarthritis index (AUSCAN). Depending on how their AUSCAN score changed over 4 years, the researchers classified patients as either improving, deteriorating or stable.
The researchers also investigated factors associated with attaining a “patient acceptable symptom state” after 4 years, defined as an AUSCAN pain score under 8.2, using logistic regression models adjusted for age, sex, BMI and pain at baseline. Potential factors included patients’ understanding of the condition, assessed with the Illness Perception Questionnaire (IPQ), and coping styles, assessed via the Coping with Rheumatic Stressors questionnaire.
At baseline, the mean AUSCAN score among study participants was 9.1 (standard deviation, 4.3). Across 4 years, 38% of participants improved, 30% deteriorated and 32% remained stable.
According to the researchers, deterioration was positively associated with BMI (OR = 1.08; 95% CI, 1.01-1.15), the “comforting cognitions” coping style (OR = 1.1; 95% CI, 1.02-1.19), and higher scores on the “illness coherence” IPQ domain (OR = 1.11; 95% CI, 1.01-1.22), which indicate “less understanding of the disease.”
Meanwhile, improved pain was negatively associated with worse AUSCAN function score (OR = 0.95; 95% CI, 0.91-1); worse depression (OR = 0.89; 95% CI, 0.8-0.98) and anxiety scores (OR = 0.91; 95% CI, 0.82-1), measured via the Hospital Anxiety and Depression scale; and the IPQ domain “consequences” (OR = 0.91; 95% CI, 0.84-0.98), which measures “consequences attributed to hand OA,” the researchers wrote.
The Patient Acceptable Symptom State (PASS) rate increased from 44% at baseline to 49% after 4 years, with 43 patients losing PASS status and 64 attaining it. Factors negatively associated with PASS included worse AUSCAN hand function (OR = 0.95; 95% CI, 0.91-0.99); tender joint count (OR = 0.91; 95% CI, 0.84-0.97) and the number of symptoms attributed to hand OA (OR = 0.81; 95% CI, 0.69-0.95).
“In this study we found that over four years, about 40% of patients will remain stable in their level of pain, with 30% experiencing a deterioration and 30% experiencing an improvement,” van der Meulen and colleagues wrote. “The patients experiencing deteriorations are identified by higher BMI, having paid work, coping through comforting cognitions and illness coherence. Patients experiencing improvements are identified by having paid work, mental wellbeing (less signs of anxiety and depression), more perceived consequences of HOA as well as better hand function.
“Over four years, the number of patients at a PASS slightly increased, which was associated with a lower number of tender joints and better hand function at baseline,” they added. “These results can help inform patients and physicians. They may support the selection of patients for trials. These observational results require validation, but could represent modifiable risk factors, and require further study in future trials.”
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