Abstract
ObjectivesPain 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.MethodsAn 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.ResultsPain 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)].ConclusionOver 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.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by inflammation of the joints, resulting in pain, stiffness and destruction of articular bone and cartilage
During the 5-year period, 17% were at some point treated with a biologic Disease-modifying anti-rheumatic drug (DMARD)
In this study, we found that approximately one third of patients with RA have unacceptable pain up to 5 years after diagnosis and that nearly two thirds of these patients have pain despite low inflammatory activity
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by inflammation of the joints, resulting in pain, stiffness and destruction of articular bone and cartilage. It has been hypothesized that central sensitisation could contribute to pain in RA, and this is supported by several studies [8, 10, 11]. Such nociplastic pain could possibly explain why a subgroup of patients with RA have pain despite inflammation control. Improved pain treatment could have many beneficial effects other than reducing pain. Some authors have argued that it is pain, and not disease activity, which drives fatigue, and that interventions to reduce pain might have beneficial effects on fatigue [19]. Remaining pain has been associated with more sickness absence [21], and improved pain management might be beneficial for patients’ work ability
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