title: Pain, physical functioning, and overeating in obese rheumatoid arthritis patients: do thoughts about pain and eating matter?
abstract: BACKGROUND
  Obese rheumatoid arthritis (RA) patients have higher levels of pain, disability, and disease activity than do nonobese patients with RA. Patients' health-related thoughts about arthritis and weight may be important to consider in obese patients with RA who face the dual challenge of managing RA and weight.
  
  
  OBJECTIVE
  The objective of this study was to examine the relationships of pain catastrophizing, self-efficacy (ie, confidence) for arthritis management and self-efficacy for weight management to important outcomes in obese patients with RA. We expected that after controlling for demographic and medical variables, higher levels of pain catastrophizing and lower levels of confidence would account for significant and unique variance in pain, physical functioning, and overeating.
  
  
  METHODS
  Participants had a diagnosis of RA and a body mass index of 28 kg/m or greater and completed self-report questionnaires assessing pain, physical functioning, overeating, pain catastrophizing, self-efficacy for arthritis management, self-efficacy for weight management, and a 6-minute walk test.
  
  
  RESULTS
  Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management were significantly and uniquely related to RA-related outcomes. Pain catastrophizing was a significant independent predictor of pain severity (β = 0.38); self-efficacy for arthritis was a significant independent predictor of self-report physical functioning (β = -0.37) and the 6-minute walk performance (β = 0.44), and self-efficacy for weight management was a significant independent predictor of overeating (β = -0.58).
  
  
  CONCLUSIONS
  Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management each contributed uniquely to relate to key outcomes in obese patients with RA. Clinicians should consider assessment of thought processes when assessing and intervening with patients who face dual health challenges; unique intervention approaches may be needed for addressing the challenges of arthritis and weight.
authors.affiliation: From the Duke University Medical Center, Durham, NC.
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Somers
authors.forename: Anava A
authors.initials: AA
authors.lastname: Wren
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: David
authors.initials: D
authors.lastname: Caldwell
authors.forename: Kim M
authors.initials: KM
authors.lastname: Huffman
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D001828:Body Image / Q000523:psychology; D015992:Body Mass Index; D058443:Catastrophization / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000523:psychology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D010147:Pain Measurement; D010809:Physical Fitness / Q000502:physiology; D020377:Self Efficacy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires