Background Affective distress (clinically significant depression, anxiety and stress) and central sensitization (CS) are consistently associated with the reported sensitivity and severity of pain, physical disability, poor treatment outcomes, and inflammatory disease activity, and potentially with early mortality in rheumatoid arthritis (RA).

Objectives We aimed to explore affective distress in patients with RA and determine how they connected to CS.

Methods Used the CSI to measure CS and the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) to evaluate the negative emotional states of depression, anxiety and stress. The total CSI score ranges from 0 to 100, and a score of 40 or greater has been established to indicate CS. Each of the three DASS-21 scales contains 7 items, divided into subscales with similar content. Multiple regression analysis was used to find out which factors were most likely to be linked to CS.

Results Overall we included 192 RA patients (age ranging from 22 to 86 years) with a mean disease duration of 5.95 (SD 13.75) years. The CSI score was ≥ 40 in 70/192 patients (36.5%). In our RA cohort, the DASS-21 total score was 32.3 (SD29.8). The mean Anxiety score (Mean=10.68 and SD=8.92 was in the moderate range (10-14), whereas the mean Depression (Mean = 10.11 and SD = 11.66) and Stress (Mean = 15.8 and SD=12.05) scores were in the mild range (10-13 and 15-18, respectively). In the 70 patients with CSI score > 40, the mean Anxiety score (Mean=12.20 and SD=10.01) and the mean Depression (Mean = 14.01 and SD = 13.83) and Stress (Mean = 19.51 and SD=12.77) scores were all in the moderate range (10-14, 14-20 and 19-25, respectively).

Conclusion Affective distress symptoms (clinically significant depression, anxiety and stress) and CS are common in RA patients. Screening and recognition of such psychosocial disorders may help patients achieve optimal disease control and a good outcome. Overall, our findings have implications for health policy and emphasize the significance of identifying high-risk fibromyalgia (FM) patients by monitoring CS as an indicator of severe disease.

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[2]Ruhaila AR, Chong HC. Self-reported symptoms of depression, anxiety and stress among patients with Rheumatoid Arthritis in a Malaysian rheumatology centre - prevalence and correlates. Med J Malaysia. 2018 Aug;73(4):226-232.

[3]Bacconnier L, Rincheval N, Flipo RM, Goupille P, Daures JP, Boulenger JP, Combe B. Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort. Rheumatology (Oxford). 2015 Mar;54(3):520-7.

Acknowledgements: NIL.

Disclosure of Interests None Declared.