Neuropathic pain in a sample of Egyptian patients with rheumatoid arthritis

Abdullah Radwan,Ahmed Borai

doi:10.1186/s43166-020-00047-w

Abstract

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by polyarthritis that may cause irreversible joint disability. Pain is the most important symptom in RA patients that requires more attention and careful evaluation. Despite the improvement in medications used to control inflammation in RA patients, a relevant number of them still experience neuropathic pain even with disease remission. This study was conducted to estimate the frequency of neuropathic pain (NP) in RA patients and to assess its relationship with disease activity, functional status, and overweight.ResultsNP was detected in 12.5% (14 patients) of RA patients. Highly significant differences were found between RA patients with NP and those without NP as regards disease duration, visual analog scale (VAS) of pain, disease activity score 28 (DAS28-ESR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), body mass index (BMI), health assessment questionnaire (HAQ) score, and Douleur Neuropathique in 4 (DN4) questionnaire for NP assessment (p < 0.001). The correlation between the DN4 questionnaire and the parameters of disease activity in RA patients with NP was not significant. By univariate analysis, the possible risk factors for NP in RA patients were disease duration, VAS, DAS28-ESR, HAQ, and BMI; however, by multivariate analysis, no possible risk factors for NP in RA patients were detected.ConclusionAlthough pain in patients with RA was classified as nociceptive in nature, a relevant proportion of patients might also have NP. NP in RA patients was related to functional disability, high disease activity, and overweight.

Highlights

Rheumatoid arthritis (RA) is an autoimmune disease characterized by polyarthritis that may cause irreversible joint disability
Significant differences were found between the two groups as regards disease duration, visual analog scale (VAS), DAS28-erythrocyte sedimentation rate (ESR), ESR, C-reactive protein (CRP), body mass index (BMI), health assessment questionnaire (HAQ), and Douleur Neuropathique in 4 (DN4) (p < 0.001) (Table 1)
The univariate binary regression analysis showed that disease duration, VAS, total joint counts (TJCs), swollen joint counts (SJCs), DAS28ESR, ESR, CRP, BMI, and HAQ are possible risk factors for neuropathic pain (NP) in RA patients (Table 3); no possible risk factors for NP in RA patients were detected by the multivariate analysis (Table 4)

Summary

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease characterized by polyarthritis that may cause irreversible joint disability. Pain is the most important symptom in RA patients that requires more attention and careful evaluation. Despite the improvement in medications used to control inflammation in RA patients, a relevant number of them still experience neuropathic pain even with disease remission. This study was conducted to estimate the frequency of neuropathic pain (NP) in RA patients and to assess its relationship with disease activity, functional status, and overweight. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by persistent, progressive synovitis, and structural damage that can result in progressive disability and loss of function [1]. Despite the significant improvement in RA management, persistent pain still presents in a relevant number of RA patients. Careful pain evaluation in RA patients will result in more advanced control of pain and better disease outcome [2]. Because of the overlap that can occur between NP and nociceptive pain in the pathophysiological mechanisms, several instruments have been developed for the assessment of pain [8]

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Discussion

Conclusion