Psychological Burden of Rheumatoid Arthritis in Bangladesh: The Influence of Pain Catastrophizing and Depression

Depression is a common issue among individuals with RA and is often linked to increased pain levels, greater disability and poorer overall health outcomes. Pain catastrophizing, which is frequently observed in people experiencing chronic pain, tends to worsen both physical discomfort and emotional distress related to rheumatic conditions. Owing to its significant impact, it has become a primary focus in recent treatment approaches. This cross-sectional study was conducted at the Rheumatology Department of Bangladesh Medical University in Dhaka. Adults aged 18 years or older who met the 2010 ACR/EULAR classification criteria for rheumatoid arthritis were consecutively enrolled from outpatient and inpatient services. Data collected included demographic information, clinical details, disease duration, number of affected joints, morning stiffness, ESR and CRP levels. Disease activity was assessed using the CDAI and DAS28-ESR/CRP scales; functional disability was measured with the HAQ-DI; pain intensity was evaluated via a 0-10 visual analogue scale (VAS); depressive symptoms were assessed using the PHQ-9; and pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). Multivariable logistic regression identified independent predictors of depression. The participants' average age was 42.11±11.87 years, with the majority being female (81.8%). A high proportion (54.7%) was classified as overweight or obese. Disease activity was moderate, with a mean CDAI of 13.48±8.13 and a mean DAS28-ESR of 4.18±1.09. Functional impairment was notable, with a mean HAQ-DI score of 1.66±0.78. The average PHQ-9 score was 10.42±5.66 and the mean PCS score was 24.30±11.46. Nearly 90.0% of patients showed at least mild depressive symptoms, with mild (41.2%) and moderate (24.3 %) depression being the most common; 17.6% experienced moderate-to-severe depression and 6.8% had severe depression. Depression severity correlated with higher disease activity scores, with those with severe depression showing the highest CDAI values (≈17.21) compared to those with mild depression (≈7.03). In the multivariable analysis, higher VAS pain scores (odds ratio [OR] 1.56, p=0.02), greater functional disability (HAQ-DI; OR 7.34, p<0.001) and higher PCS scores (OR 7.99, p<0.001) were significant independent predictors of depression. After adjusting for other factors, sex, tobacco use, joint count, morning stiffness, inflammatory markers, CDAI and DAS28 scores were not independently associated with depression. People with RA in Bangladesh face higher rates of depression compared to other groups, mainly due to pain and physical limitations, as well as adverse reactions to pain, rather than from inflammatory disease processes. The findings highlight the importance of including depression screening and pain-related cognitive assessments in RA treatment plans, especially in resource-limited settings.