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Psychosomatic Medicine 32:309-318 (1970)
© 1970 American Psychosomatic Society

Pain and Mood Patterns in Patients with Rheumatoid Arthritis

A Prospective Study

H. MOLDOFSKY MD1 and W. J. CHESTER PhD1

1 Rheumatic Diseases Unit, Wellesley Hospital Toronto, Department of Psychiatry, University of Toronto, Canada

Address for reprint requests: Dr. H. Moldofsky, Clarke Institute of Psychiatry, 250 College Street, Toronto 2B, Canada

Sixteen randomly selected patients, fulfilling the American Rheumatism Association criteria for definite or classic rheumatoid arthritis, were involved in a longitudinal psychosomatic study during their stay on a rheumatic diseases unit. After initial rheumatologic and psychiatric evaluation, twice daily mood and pain ratings were conducted by a single observer employing a mood adjective check list and a dolorimeter for measuring all upper limb peripheral joint tenderness. Twenty-one separate studies, each averaging 36 days, were carried out; 3 patients were studied on at least one other occasion. Two pain-mood patterns emerged: a synchronous state, characterized by mood changes within an anxiety or hostility spectrum, either closely preceding or concomitant with fluctuations in joint tenderness; and a paradoxical state, characterized by an inverse relationship between intensity of joint tenderness and a sense of hopelessness. The patients' age, sex, social class, duration of illness, radiologic joint changes, functional disability and medication bore no relationship to these patterns. In a 1-2 year follow-up of the 2 groups of 8 patients each, the paradoxical group predictably demonstrated a less favorable outcome.

Submitted on August 28, 1969
Revised on December 11, 1969




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