The associations between poorer pain-related health status and increased hospitalisations and excess mortality in patients with rheumatoid arthritis (RA): a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD) (2024)

1. http://orcid.org/0000-0002-0425-1697Huai Leng Pisaniello1,2,
2. Susan Elizabeth Lester2,3,
3. Oscar Russell1,2,3,
4. Rachel Black2,3,
5. Joanna Tieu2,3,
6. Bethan Richards4,5,6,
7. Claire Barrett7,8,
8. Marissa Lassere9,10,
9. http://orcid.org/0000-0003-1736-8111Lyn March11,12,
10. http://orcid.org/0000-0002-0597-0933Rachelle Buchbinder13,
11. Catherine Hill2,3,
12. http://orcid.org/0000-0001-7417-7691Samuel Lawrance Whittle2,3,13

1. ¹Discipline of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
2. ²Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
3. ³Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
4. ⁴Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
5. ⁵Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
6. ⁶Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
7. ⁷Department of Rheumatology, Redcliffe Hospital, Redcliffe, Queensland, Australia
8. ⁸Department of Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
9. ⁹Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
10. ¹⁰Department of Medicine, University of New South Wales School of Population Health, Sydney, New South Wales, Australia
11. ¹¹Florence and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
12. ¹²Institute of Bone and Joint Research at Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
13. ¹³School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

1. Correspondence to Dr Huai Leng Pisaniello, Discipline of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia; huaileng.pisaniello{at}adelaide.edu.au

• Arthritis, Rheumatoid
• Cause of Death
• Pain
• Mortality

Pain is a highly prioritised patient-reported symptom in rheumatoid arthritis (RA).1 Persistent pain in RA may exist despite minimal disease activity and is often experienced as non-inflammatory or chronic widespread pain (CWP), which can be overlooked by rheumatologists and health professionals.1 In the general population, CWP is associated with increased mortality rates, primarily driven by poor lifestyle factors.2 Limited physical and psychosocial health and poor self-efficacy can adversely affect the overall health trajectory in those with persistent pain.3 4 Concerningly, greater use of opioids and anti-inflammatory drugs and more biologic therapy modifications are seen in those with poorer pain-related health status trajectory in RA.5 While RA is associated with higher mortality, it is unknown if poorer pain-related health status is associated with RA-related adverse health outcomes such as hospitalisation and mortality.6

Using the Australian Rheumatology Association Database (ARAD), a large voluntary national registry with longitudinal self-reported data on treatment and health outcomes in inflammatory arthritis, we identified distinct trajectory groups of pain-related health states in participants aged 25–75 years, with rheumatologist-diagnosed RA. These participants entered ARAD within 5 years of diagnosis, with at least 3 years of follow-up and provided data linkage consent. Mortality data linkage to the Australian Death Registry was performed in early 2020. Distinct multi-trajectories using five different self-reported pain-related health outcome measures (Health Assessment Questionnaire Disability Index, visual analogue scores for pain, arthritis, global health and the Assessment of Quality of Life-Utility Index) were identified using latent discrete mixture modelling. Using these identified trajectory groups as predictors, we examined their relationship with hospitalisation, mortality …

Footnotes

• Handling editor Josef S Smolen

• X @huaileng_jess, @lynmarch1, @rachellebuch, @samwhittle

• Presented at This study was previously presented in part as a poster presentation at the Australian Rheumatology Association (ARA) 63rd Annual Scientific Meeting (Tasmania, Australia) in May 2023 and was previously published in abstract form in Internal Medicine Journal (Pisaniello, HL, Lester, S, Russell, O, et al. ARA-P22; Poorer pain-related health status in patients with rheumatoid arthritis correlates with an increase in hospitalisations and mortality: A prospective cohort analysis using the Australian rheumatology association database; Internal Medicine Journal, 2023, Volume 53, Issue S1 - https://onlinelibrary.wiley.com/doi/10.1111/imj.16057).

• Contributors HLP, SEL, CH and SLW contributed to the conception and design of the work, the acquisition, analysis and interpretation of the data. HLP contributed to the main drafting and the writing of the manuscript and all authors (HLP, SEL, OR, R Black, JT, BR, CB, ML, LM, R Buchbinder, CH, SLW) contributed to the subsequent drafting and revision of the manuscript. All authors (HLP, SEL, OR, R Black, JT, BR, CB, ML, LM, R Buchbinder, CH, SLW) read and approved the final manuscript.

• Funding The Australian Rheumatology Association Database (ARAD) receives support of unrestricted educational grants administered through the Australian Rheumatology Association from Pfizer Australia, AbbVie Pty Ltd, Eli Lilly Australia Pty Ltd, Sanofi Australia, Celgene Australian & NZ, Bristol Myers Squibb Australia Pty Ltd, Amgen Australia Pty Ltd, Aventis, AstraZeneca and Roche. ARAD was previously supported by an Australian National Health and Medical Research Council (NHMRC) Enabling Grant (ID 384330). Infrastructure support for ARAD is provided by Cabrini Health, Monash University, Royal North Shore Hospital and the Australian Rheumatology Association (ARA). This manuscript formed part of HLP’s PhD work, for which HLP was the recipient of the Ken Muirden Overseas Training Fellowship from the Arthritis Australia, an educational grant funded by the ARA, and HLP also received the Australia Postgraduate Scholarship from the University of Adelaide. R Buchbinder is funded by an NHMRC Investigator Fellowship (APP1194483).

• Competing interests None declared.

• Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

• Provenance and peer review Not commissioned; externally peer reviewed.

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