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A framework for the development of chronic pain over time is depicted through a data-driven structural equation model utilizing longitudinal data. The baseline biological risk is calculated using a blood risk score for RA, derived from 52 blood markers encompassing inflammatory and immune, metabolic and haematological assays. Baseline psychosocial risk is quantified using a psychosocial risk score for RA, derived from 90 pain-agnostic features that include mental, physical and sociodemographic factors. Pain diagnosis denotes the onset of healthcare diagnosed RA between the initial risk assessment and the online follow-up pain questionnaire roughly 10 years later. Pain outcomes encompass the interference of chronic pain across several dimensions (pain impact), the count of self-reported chronic pain sites (pain spread) and the rating of the worst pain in the last 24 h (pain intensity) in the online pain questionnaire. Arrows are labelled with regression coefficients derived from the structural equation modelling. Arrows are drawn only for significant associations. * P < 0.0001; bootstrap (1,000 iterations) tests were used for significance testing of regression coefficients; Med., median; Num., number.

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