THU0659 CATASTROPHIZING IN RHEUMATOLOGY

Background: Rheumatic disorders (RD) provide chronic pain. Catastrophizing is a negative cognitive and affective response resulting in inadequate expression of pain. Catastrophizing in RD patients is suspected to be involved in persistence and amplification of chronic pain. Objectives: To assess catastrophizing level in RD and to evaluate the association between catastrophizing and physical pain intensity, disease activity, disability, depression and quality of life. Methods: We performed a systematic review of literature and search in the following databases: MEDLINE, COCHRANE and EMBASE until April 2018. All observational, cross-sectional and randomized control studies investigating catastrophizing in patients with RD (rheumatoid arthritis (RA), low back pain (LBP), osteoarthritis) were included. Statistical analysis defined pooled mean catastrophizing level by using the Pain Catastrophizing Scale (PCS), the latter ranging from 0 to 52. To assess the association between catastrophizing and disease activity (DAS28), pain (Numerical Rating Scale NRS), disability (ODI) and quality of life (SF36, WOMAC) we collected correlation coefficients and pooled them in meta-analysis using the Fisher’s z transformation with MedCalc v18.11.3. Results: From 1494 articles concerning catastrophizing and RD, 51 were selected for a meta-analysis : - 601 RA patients (mean age 57.4 years, 67.7% female, mean pooled DAS 28 = 3.4 and mean pooled NRS = 3.8) included in 7 studies. The mean pooled catastrophizing level at baseline was 14.7 (SD = 11.4) in RA patients vs 2.7 (SD = 3.0) in control group patients (n= 82 in 2 studies). In one study, a RA sample identified 22% of high catastrophizers (defined by PCS > or = 30). - 2521 LBP patients (mean age 43.6 years, 57% female, mean pooled NRS = 4.5 and mean pooled ODI = 30.3) included in 27 studies. The mean pooled catastrophizing level at baseline was 19.9 (SD = 11.3). - 3388 osteoarthritis patients (knee and hip, mean age 67.7 years, 65% female, mean pooled NRS = 5.0) included in 17 studies. The mean pooled catastrophizing level at baseline was 11.2 (SD = 10). In RA, a significant positive correlation between catastrophizing and DAS 28 was observed: pooled r=0.278 p<0.001 (3 studies) (Figure 1). Pain level was strongly associated with catastrophizing (r=0.71 (p<0.01). Higher PCS scores were significantly associated with higher levels of distress i.e. lower SF-36 Mental Health score (r= -0.52 (p<0.01)) and significantly associated with reduced physical function (r=-0.35 (p<0.01) for SF36 Physical Function). In LBP, higher PCS scores were significantly associated with higher levels of pain and disability : pooled r=0.486 p<0.001 (NRS) and r=0.465 p<0.001 (ODI), respectively. The association between catastrophizing and depression was significant (r=0.538 p<0.01). Catastrophizing in osteoarthritis was strongly associated with an increase in functional limitations and pain (i.e. higher WOMAC total score, correlation coefficient: r= 0.641 p<0.001). Conclusion: Catastrophizing is a common psychological trait clearly associated with disease activity, pain, mental health and physical function. Nevertheless catastrophizing is rarely measured. It might be relevant to detect it earlier in order to adapt pharmacologic and non-pharmacologic treatment in at-risk patients.Figure 1 Forest plot for correlation coefficient between catastrophizing (PCS) and disease activity (DAS 28) in rheumatoid arthritis Disclosure of Interests: Soraya Benamar: None declared, Charlotte Hua: None declared, Jacques Morel: None declared, Francoise Flaisler: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Cédric Lukas: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma.