P116 Is physical activity associated with central sensitisation indices or pain in rheumatoid arthritis?

Abstract

Background/Aims Rheumatoid arthritis (RA) is a chronic condition where pain often persists despite controlled inflammation. Central sensitisation (CS), characterised by an amplified response of the central nervous system to nociceptive inputs, drives this persistent pain. While physical activity is important for health, its effectiveness in reducing pain and CS in RA is unclear. This study investigates whether self-reported physical activity levels influence pain and CS indices. Methods Ninety-two participants with RA from the Central Aspects of Pain in RA (CAP-RA) cohort completed the International Physical Activity Questionnaire (IPAQ) at baseline, categorising physical activity levels as Low, Moderate, or High. Quantitative Sensory Testing (QST) modalities, including pressure pain thresholds (PPT), temporal summation (TS), and conditioned pain modulation (CPM) were used as CS indices. Pain severity was the sum of 3 numerical rating scales (NRS) from the painDETECT questionnaire. Disease activity was assessed using the Disease Activity Score 28 (DAS28). Sixty-four participants provided 3-month follow-up data. Spearman’s correlations and multivariable linear regressions explored associations between physical activity, CS indices, and pain at baseline and over time. Results The median age of participants was 65 (range: 30,85) years. The majority were female (87%). Participants reported moderate pain, with a median pain severity score of 20 (IQR 16, 23) out of 30, and moderate disease activity (median DAS28: 4.5 [IQR 3.8,5.2]). DAS28 decreased by a median of -0.14 (IQR -1.1,+0.7), and median CRP decreased from 5.0 mg/L (IQR 2.0,8.0) to 4.5 mg/L (IQR 2.0,7.0) from baseline to follow-up. About half (54%) reported low physical activity levels, with no significant group change in physical activity from baseline to follow-up. However, 46% of participants transitioned between activity categories, indicating some movement in physical activity levels. Bivariate correlations revealed no significant associations between baseline physical activity and CS indices or pain, nor between change in physical activity and change in CS indices or pain. Multivariable linear regression showed that increases in CS indices and pain severity were most strongly predicted by their baseline values (β = range -1.05 to -0.25, all p < 0.05), but not by physical activity levels. Additionally, male sex significantly predicted increased TS (pain sensitivity) (β = 1.28 ,p =0.01), and high baseline swollen joint count was a significant predictor for increased pain severity after 3 months (β = 0.31, p = 0.02). Conclusion These findings indicate that people with RA who are more physically active do not tend to have lower pain sensitivity or pain, either at baseline or over time. Other factors, such as sex and inflammation, might have a greater impact on CS and pain than physical activity. This highlights the need for tailored interventions that effectively target central pain mechanisms to improve pain management in RA, over and above advice to increase physical activity. Disclosure A.A. Ibrahim: None. S. Smith: None. V. Georgopoulos: None. D. McWilliams: Grants/research support; DM-grant support from Pfizer and Eli Lilly. D.A. Walsh: Consultancies; Since 2015 he has undertaken consultancy through the University of Nottingham to AbbVie Ltd, Pfizer Ltd, Eli Lilly and Company, Love Productions, Reckitt Benckiser Health Limited and GSK (each non-pe). Honoraria; he has received speaker fees from the Irish Society for Rheumatology (personal pecuniary). Grants/research support; he has been responsible for research funded by Pfizer, Eli Lilly, UCB Pharma (non-personal, pecuniary); he receives salary from the University of Nottingham, who have received funding for that purpose. Other; he has contributed to educational materials via the University of Nottingham, supported by Medscape Education, New York, International Association for the Study of Pain, and Osteoarthritis Research.