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Phenotypes of Chronic Overlapping Pain Multimorbidity in Rheumatology: A Population-Based Claims Study
Di Lu1, Kristen Cunanan1, James Cragun1
1Stanford University School of Medicine, Stanford, California.
Arthritis Care & Research
|May 18, 2026
Summary
Over half of adults with autoimmune rheumatic diseases (ARDs) experience chronic overlapping pain conditions (COPCs). Distinct multimorbidity patterns and common co-occurrences highlight the need for integrated pain management strategies.
Area of Science:
- Rheumatology
- Pain Medicine
- Epidemiology
Background:
- Autoimmune rheumatic diseases (ARDs) are frequently associated with chronic pain.
- Chronic overlapping pain conditions (COPCs) represent a complex challenge in pain management.
- Understanding COPC multimorbidity in ARD patients is crucial for effective treatment.
Purpose of the Study:
- To characterize the prevalence and patterns of chronic overlapping pain conditions (COPCs) multimorbidity in adults with autoimmune rheumatic diseases (ARDs).
- To identify distinct multimorbidity patterns and co-occurrence frequencies of COPCs within the ARD population.
Main Methods:
- Analysis of large-scale claims data (2008-2021) from 149,742 patients diagnosed with ARDs.
- Assessment of COPC prevalence, multimorbidity patterns, and pairwise co-occurrence using statistical measures (observed/expected ratios, odds ratios).
- Inclusion of specific ARDs (e.g., rheumatoid arthritis, lupus) and common COPCs (e.g., fibromyalgia, chronic low back pain).
Main Results:
- 57.5% of ARD patients had at least one COPC, with 22.7% experiencing multiple.
- Chronic low back pain (41.4%) and fibromyalgia (21.1%) were the most common COPCs.
- Significant co-occurrences were observed between various COPCs, such as fibromyalgia and chronic low back pain (O/E ratio 1.35).
Conclusions:
- A substantial burden of COPCs and unique multimorbidity patterns exist in ARD patients.
- Shared pathophysiological mechanisms may underlie the co-occurrence of ARDs and COPCs.
- Routine COPC screening and targeted multimodal interventions are recommended for improved pain management in ARD patients.
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