Association of Pain With Body Image and Psychological Resilience in Rheumatoid Arthritis and Fibromyalgia

Rheumatoid arthritis (RA) is a chronic inflammatory painful disease frequently accompanied by persistent pain, functional limitations, fatigue, and psychological distress. Fibromyalgia (FM) is characterized by chronic widespread pain and multiple symptoms including fatigue, non-restorative sleep, and cognitive complaints; psychological and social factors may also contribute to symptom burden. In both conditions, altered pain processing and central sensitization may influence symptom severity and daily functioning. Body image refers to an individual's perceptions, feelings, and thoughts about their own body, including appearance and physical functioning; chronic pain and disability can negatively affect body image and quality of life.

Objective: The primary aim of this study is to investigate, in a cross-sectional and comparative manner, the association between psychological resilience and body image in RA and FM, and to compare results with a healthy control group.

Design and Setting: Cross-sectional, comparative study conducted in the Physical Medicine and Rehabilitation Clinic at Samsun Training and Research Hospital.

Participants: Adults aged 18-65 years. The study will include approximately 42 participants with FM (meeting ACR 2016 criteria), 42 participants with RA (meeting ACR criteria; disease activity assessed using DAS28), and 40 healthy controls without a history of chronic pain or chronic disease.

Procedures and Measures: After written informed consent, demographic variables (age, sex, height, weight, body mass index, occupation, education), comorbidities, and medication use will be recorded. Participants will complete validated instruments including the Connor-Davidson Resilience Scale (CD-RISC), Body Image Scale (BIS), Beck Depression Inventory (BDI), Central Sensitization Inventory (CSI), Short Form-36 (SF-36), Somatosensory Amplification Scale (SAS), and the Revised Fibromyalgia Impact Questionnaire (FIQR) (FM group). Somatosensory assessment will be performed using the Two-Point Discrimination test. RA disease activity will be evaluated using DAS28.

Sample Size: Power analysis (G*Power) indicated a minimum total sample size of approximately 102 participants (34 per group).

Statistical Analysis: Group comparisons will be performed using appropriate parametric or non-parametric tests based on data distribution. Associations between resilience, body image, central sensitization, sensory measures, and quality-of-life outcomes will be assessed using correlation analyses. A p-value <0.05 will be considered statistically significant.

Inclusion criteria

• Adults aged 18-70 years.
• For the fibromyalgia group: meeting the ACR 2016 criteria.
• For the rheumatoid arthritis group: meeting the ACR classification/diagnostic criteria.
• For the healthy control group: no history of chronic pain or chronic disease.
• Willingness to participate and provision of written informed consent.

Exclusion criteria

• Presence of an acute or chronic neurological disease.
• Current or past psychiatric diagnosis.
• Severe visual or hearing impairment.
• History of trauma or surgery within the past 6 months.
• History of cancer.
• Thyroid disease.
• Refusal to participate / inability to provide informed consent.