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. 2021 Jun 14;23(1):169.
doi: 10.1186/s13075-021-02550-7.

Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis-an inception cohort study

Anna Eberhard  1 , Stefan Bergman  2   3 , Thomas Mandl  4 , Tor Olofsson  2   5 , Maria Rydholm  4   5 , Lennart Jacobsson  6 , Carl Turesson  4   5
Affiliations

Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis-an inception cohort study

Anna Eberhard et al. Arthritis Res Ther. .

Abstract

Objectives: Pain is a major symptom in patients with rheumatoid arthritis (RA). In early RA, pain is usually due to synovitis, but can also persist despite effective anti-inflammatory treatment. The objective of this study was to investigate the pain course over time and predictors of unacceptable pain and unacceptable pain with low inflammation, in patients with early RA.

Methods: An inception cohort of 232 patients with early RA, recruited in 1995-2005, was followed in a structured programme for 5 years. Pain was assessed using a visual analogue scale (VAS; 0-100). Unacceptable pain was defined as VAS pain > 40 based on the patient acceptable symptom state (PASS) and low inflammation as CRP < 10 mg/l. Baseline predictors of unacceptable pain were evaluated using logistic regression analysis.

Results: Pain improved significantly during the first 6 months, but then remained basically unchanged. Thirty-four per cent of the patients had unacceptable pain 5 years after inclusion. Baseline predictors of unacceptable pain after 5 years were lower swollen joint counts [odds ratio (OR) 0.71 per standard deviation (95% confidence interval (CI) 0.51-0.99)] and higher VAS for pain and global assessment of disease activity. Unacceptable pain with low inflammation after 5 years was negatively associated with anti-CCP antibodies [OR 0.50 (95% CI 0.22-0.98)].

Conclusion: Over one third of the patients had unacceptable pain 5 years after inclusion. Lower swollen joint count was associated with unacceptable pain at 5 years. The results may be explained by the positive effects of treatment on pain related to inflammation. Non-inflammatory long-lasting pain appears to be a greater problem in anti-CCP-negative patients.

Keywords: Non-inflammatory pain; Pain; Predictor; Rheumatoid arthritis.

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Conflict of interest statement

C.T. has received consulting fees from Roche, speaking fees from Abbvie, Bristol Myers-Squibb, Pfizer and Roche, and an unrestricted grant from Bristol Myers-Squibb. T.M. is an employee of the pharmaceutical company Novartis, working as medical advisor in rheumatology. Jacobsson L.T.H. has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily, and Janssen. T.O. has performed consulting tasks for Eli Lilly, and Merck Sharp & Dohme unrelated to the present work.

Figures

Fig. 1
Fig. 1
a Mean VAS pain from inclusion to 5 years in patients with early RA. Legend: Mean VAS pain over time, with 95% confidence intervals. There was a reduction in mean VAS pain from inclusion to 6 months. Mean VAS pain was thereafter more or less unchanged over time. b Mean change in pain between every follow-up visit. Legend: Paired samples t test. VAS pain decreased significantly from inclusion to 6 months. After 6 months there was no significant change in pain between the follow-up visits. VAS: visual analogue scale
Fig. 2
Fig. 2
Percentage of patients with unacceptable pain over time, overall and in patients with low inflammation, in early RA
See this image and copyright information in PMC

References

    1. Hekmat K, Jacobsson LT, Nilsson J, Lindroth Y, Turesson C. Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA-results from a community based study. BMC Musculoskelet Disord. 2014;15(1):44. doi: 10.1186/1471-2474-15-44. - DOI - PMC - PubMed
    1. Pincus T, Sokka T, Kautiainen H. Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985. Arthritis Rheumatism. 2005;52(4):1009–1019. doi: 10.1002/art.20941. - DOI - PubMed
    1. Thyberg I, Dahlstrom O, Bjork M, Stenstrom B, Adams J. Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project. Disabil Rehabil. 2017;39(3):291–300. doi: 10.3109/09638288.2016.1140835. - DOI - PubMed
    1. Ahlstrand I, Thyberg I, Falkmer T, Dahlstrom O, Bjork M. Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project. Scand J Rheumatol. 2015;44(4):259–264. doi: 10.3109/03009742.2014.997285. - DOI - PubMed
    1. Martins Rocha T, Pimenta S, Bernardo A, Bernardes M, Barbosa M, Lucas R, et al. Determinants of non-nociceptive pain in rheumatoid arthritis. Acta Reumatol Portuguesa. 2018;43(4):291–303. - PubMed

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