P057 The relationship between pain and mental health in people with inflammatory arthritis: a systematic review

Cox, Natasha; Hawarden, Ashley; Kettle, Chelsea; Bajpai, Ram; Farooq, Saeed; Twohig, Helen; Muller, Sara; Scott, Ian

Abstract

Background/Aims Pain is common in inflammatory arthritis (IA) and understanding how to best treat it is important. Depression/anxiety are prevalent IA-comorbidities. The evidence they associate with pain is uncertain. This PROSPERO-registered (CRD42023411823) systematic review defined the associations between pain and depression/anxiety, and evaluated the impact of treating depression/anxiety on pain, in IA. Methods A comprehensive search (to May-2023) identified studies in adults with rheumatoid arthritis/spondyloarthritis reporting pain-depression/anxiety associations or impacts of treating depression/anxiety on pain. Vote-counting (direction of effect) and/or random-effects meta-analysis summarised single time-point associations. Narrative synthesis summarised longitudinal associations/mediators/treatment impacts. Quality was assessed using JBI critical appraisal tools. Results Included Studies: 79 (from 15,998 citations). Correlations: meta-analysis showed weak-to-moderate correlations between pain intensity and depression (r = 0.36 [95%CI 0.32,0.40]; 34 studies) and anxiety (r = 0.37 [0.31,0.42]; 21 studies). Pain Intensity by Presence/Absence of Depression/Anxiety: vote-counting indicated higher pain in those with vs. without depression (18/18 studies) or anxiety (11/11 studies), supported by meta-analysis for depression (standardised mean difference [SMD]=0.69 [0.54,0.84]) and anxiety (SMD=0.62 [0.47,0.77]). Mental Health (Explanatory Variable) and Pain Intensity (Outcome) Association: vote-counting studies using linear regressions showed worse depression (7/8 studies) and anxiety (4/5 studies) associated with worse pain. Meta-analysis demonstrated depression (SMD=0.65 [0.31,0.99]) moderately, and anxiety (SMD=0.03 [0.001,0.05]) negligibly, associated with pain. In narrative synthesis, depression associated with pain longitudinally over the short/medium-term (5 studies), with limited long-term evidence (1 study); anxiety associated with pain over the short and long-term (3 studies). Mental Health Scores by Pain Intensity Categories: vote-counting indicated worse depression (6/7 studies) and anxiety (3/3 studies) in higher pain categories. Pain Intensity (Explanatory Variable) and Mental Health (Outcome) Association: vote-counting studies using logistic regressions showed worse pain associated with worse depression (4/5 studies) and anxiety (4/4 studies). Meta-analysis showed minimal increases in the odds of depression (OR = 1.02 [1.00,1.04]) but not anxiety (OR = 1.02 [0.99,1.05]) with increasing pain. Vote-counting in studies using linear regressions showed worse pain associated with worse depression (6/7 studies) and anxiety (5/5 studies). Meta-analysis demonstrated small/moderate associations with depression (SMD=0.24 [0.03,0.45]) and anxiety (SMD=0.55 [0.20,0.91]). In narrative synthesis, worse pain associated with worse depression (4/6 studies) longitudinally, with mixed findings for anxiety (2 studies). Mediators: 1 study reported passive coping mediated depression-pain associations; another reported mood did not. Treating Mental Health: anti-depressants (for depression) showed potential for reducing pain (3 trials). Combination psychological-pharmacological treatment did not improve pain beyond pharmacological treatment (1 trial). Study Quality:35% of studies were at high, 34% moderate, and 30% low risk of bias. Conclusion This comprehensive evidence synthesis indicates a bidirectional pain-depression relationship in IA, while evidence for anxiety appears less robust/inconsistent. High-quality studies are needed to define long-term associations, relationship mediators, and mental health treatment impacts on pain, to best inform pain management approaches. Disclosure N. Cox: None. A. Hawarden: None. C. Kettle: None. R. Bajpai: None. S. Farooq: None. H. Twohig: None. S. Muller: None. I. Scott: None.

Citation

Cox, N., Hawarden, A., Kettle, C., Bajpai, R., Farooq, S., Twohig, H., Muller, S., & Scott, I. (2025, April). P057 The relationship between pain and mental health in people with inflammatory arthritis: a systematic review. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 28, 2025
• Deposit Date: Jun 6, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.099
• Public URL: https://keele-repository.worktribe.com/output/1242624
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.099/8114994