The association between the experience of threats on symptom severity and pain in rheumatic diseases: A concept mapping study

Abstract

Objective. In rheumatic diseases, threatening factors are assumed to amplify pain and fatigue. In Gilbert’s affect regulation theory, threats can be of external or internal nature and are factors that create a feeling of unsafety, harm or danger. The aim of the current study was to identify threats in rheumatic diseases and their association with physical symptoms. Methods. An online survey was carried out to identify threats (study 1) in 724 patients from multiple countries. Forty threats were used in a card sorting task in 111 patients with enduring physical symptoms (107 female, mean age 48.41 yrs.; 4 male, mean age 52.50). Participants had to group the cards according to content and severity of the threat. Results. Hierarchical cluster analysis organized the 40 threats in six overarching clusters: ‘Weather’, ‘Physical factors’, ‘Social pressure and invalidation’, ‘Limits’, ‘Activities’ and ‘Negative feelings’. In 49 patients with a rheumatic disease (47 female, mean age 53.30 yrs.; 2 male, mean age 53.49 yrs.), ‘Physical factors’ and ‘Social pressure and invalidation’ were found to be associated with symptom severity. Discussion. This study yielded an encompassing set of threats that may amplify somatic symptoms and showed which threats were associated with symptom severity. In clinical practice, this knowledge can be used to screen patients and teach them, how to manage these threatening experiences or to develop self-management tools.