Anna Eberhard1, Stefan Bergman2,3, Thomas Mandl4, Tor Olofsson2,5, Maria Rydholm4,5, Lennart Jacobsson6, Carl Turesson4,5. 1. Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden. anna.eberhard@med.lu.se. 2. Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden. 3. Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 1b, 214 28, Malmö, Sweden. 5. Department of Rheumatology, Skåne University Hospital, Malmö, Sweden. 6. Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
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.
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.
Authors: Daniel F McWilliams; Olivia Dawson; Adam Young; Patrick D W Kiely; Eamonn Ferguson; David A Walsh Journal: J Pain Date: 2019-01-15 Impact factor: 5.820
Authors: Cecilia Fridén; Ulrika Thoors; Birgitta Glenmark; Eva Kosek; Birgitta Nordmark; Ingrid E Lundberg; Christina H Opava Journal: Disabil Rehabil Date: 2013-01-18 Impact factor: 3.033
Authors: Panagiota Goulia; Paraskevi V Voulgari; Niki Tsifetaki; Elias Andreoulakis; Alexandros A Drosos; André F Carvalho; Thomas Hyphantis Journal: Rheumatol Int Date: 2014-09-21 Impact factor: 2.631