PhD student: Sushmithadev Kumaradev

Title: Heterogeneity in the evolution of pain and its treatment in inflammatory rheumatic diseases: Role of sociodemographic and disease related factors.

Supervisors: Christian Roux, Aline Dugravot

Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité

Date of thesis defense : 11/2023

Thesis abstract

Multifactorial origins of pain in inflammatory rheumatic diseases (IRDs) are broadly classified as inflammatory and noninflammatory causes. Evolution of pain and treatment with opioids is not uniform to all. Sociodemographic, disease-specific, lifestyle and health characteristics are associated with pain in either early and/or longstanding IRDs. However, it remains to be elucidated if this association is constant or different through disease course while transitioning from early to longstanding phase. Disease-phase transitioning might impact the temporal evolution of pain and opioid prescription, as, this transition is accompanied by fluctuations in disease-specific characteristics, response to treatment, health, and pain coping behaviors.
Therefore, the objectives are: to evaluate the evolution of pain in IRDs as a function of sociodemographic characteristics after adjusting for objective inflammation; to identify the heterogeneity in the evolution of opioid prescriptions; and to evaluate the evolution of disease activity and its subjective components (after adjusting for objective inflammation) by opioid prescription trajectories.
Our analysis population belonged to two ongoing French cohorts that recruited participants with early rheumatoid arthritis (RA) and spondyloarthritis (SpA), namely ESPOIR and DESIR. Pain, disease activity along with its subjective components and patient-reported opioid prescription was assessed repeatedly over a follow-up of 10 and 6 years in RA and SpA.
Results showed that demographics-based differences in pain emerged most often during the course of IRDs; Those older, females, and non-Caucasians had higher pain than their counterparts during disease course not at inclusion. Socioeconomic-differences in pain started at inclusion or even before: Higher pain persisted throughout disease course in those having lower education. Four distinct opioid-prescription trajectories were observed: no/low (54 – 60%), declining (15 – 16%), augmenting (11 – 12%) and persistent (13 – 19%) opioid prescriptions. Higher disease activity and its subjective components were observed in those prescribed opioids. To conclude, non-inflammatory mechanisms play an important role in the heterogeneity in pain and opioid prescriptions in those with IRDs despite having accessible and efficient health care.


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