"Its Like Listening to the Radio with a Little Interference" Management of Pain among Patients with Psoriatic Arthritis

Background Psoriatic arthritis (PsA) is an inflammatory rheumatic disease, associated with the skin disease psoriasis. Health-related quality of life is severely affected and is suggested to be so since these people have two chronic diseases at the same time, a skin disease that causes cosmetic changes and a joint disease that causes functional limitations [1]. Both international collaborations [2] and single studies of outcome measures, disease consequences and experiences of pain in PsA emphasize that pain is one of the most important areas to focus on in the assessment and treatment of this patient group [3]. To the best of our knowledge, no studies with a qualitative design exploring the management of pain from the perspectives of patients with PsA exist. Objectives To explore and describe approaches towards pain and its management among patients with PsA. Methods A descriptive design with a qualitative inductive approach was used. Semi structured interviews were conducted with 11 participants with PsA (3 men and 8 women) recruited from one outpatient rheumatology clinic in the middle region as well as from a university hospital rheumatology clinic in the northern region of Sweden. Variation in gender, age, disease duration, activity limitation, perceived pain, fatigue, and general health was aimed at by using strategic sampling. Qualitative content analysis was used, and a pattern of theme of meaning, descriptive subthemes, and categories was constructed based on the participants’ experiences and perceptions [4, 5]. Results A main overarching theme of meaning and three subthemes describing participants’ management of pain were identified. They were ‘Taking charge of life despite the constant murmur of pain’ through ‘Sorting out vulnerability’, ‘Reaching acceptance and engagement’ and ‘Directing focus to change’. Nine categories further described the components of the management; ‘face uncertainty for the future’, ‘consider restrictions’, ‘illuminate the invisible’, ‘increase awareness’, ‘find permissive environment and social support’, ‘enhance inner endurance’, ‘reformulate emotions and thoughts ’, ‘use distracting activities’ and ‘adjust activities’ (Figure 1). Conclusion Dealing with and regulating feelings and thoughts within oneself as well as altering behavior and finding new solutions outside oneself seem to be significant for management of pain among patients with PsA. Grasping an understanding of this complex reality of living with a constant murmur of pain has the potential to improve and enhance the overall care. To support patients in taking charge of life health professionals should be able to provide team-based interventions that are underpinned by self-regulation skills and include cognitive, behavior and affective components. References [1]Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum. 2017 Dec;47(3):351-360. [2]Orbai AM, de Wit M, Mease PJ, et al. Updating the Psoriatic Arthritis (PsA) Core Domain Set: A Report from the PsA Workshop at OMERACT 2016. J Rheumatol. 2017 Oct;44(10):1522-1528. [3]Tillett W, Dures E, Hewlett S, et al. A Multicenter Nominal Group Study to Rank Outcomes Important to Patients, and Their Representation in Existing Composite Outcome Measures for Psoriatic Arthritis. J Rheumatol. 2017 Oct;44(10):1445-1452. [4]Lindgren BM, Lundman B, Graneheim UH. Abstraction and interpretation during the qualitative content analysis process. Int J Nurs Stud. 2020 Aug;108:103632. [5]Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008 Apr;62(1):107-15. Acknowledgements The authors thank the participants for generously sharing their experiences. Disclosure of Interests None Declared.