Patient Perceptions concerning Pain Management in the Treatment of Rheumatoid Arthritis

ObjectiveTo investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response.MethodsThe study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS).ResultsRemaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response).ConclusionThese results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

Altawil

Saevarsdóttir

Wedrén

et al. 2016

“…Pain is a significant problem for many patients with inflammatory polyarthritis (IP) and rheumatoid arthritis (RA) (1). Most often it is pain that initially motivates them to seek medical care (2).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Pain for Patients With Early Inflammatory Polyarthritis

Dobkin

Liu

Abrahamowicz

et al. 2013

Objective. To identify predictors of pain at 1 year in patients with early inflammatory polyarthritis (EIP).Methods. Using a prospective design, patients were examined by a rheumatologist and completed questionnaires at baseline and at 1 year after symptom onset. Separate regression analyses were run for pain intensity, sensory pain, and affective pain. Age and sex were adjusted in cross-sectional and longitudinal analyses; baseline potential predictors consisted of measures for corresponding pain values and disease activity, depression, coping scores, medication use, rheumatoid arthritis criteria being met, and duration of symptoms. Results. A total of 211 patients were enrolled in the study (mean ؎ SD age 58.8 ؎ 14.2 years, 63% women). There were significant improvements at 1 year for disease activity, instrumental coping, emotional coping, depression, and all 3 pain measures. At baseline, disease activity and depression were positively associated with all types of pain; in addition, instrumental coping was positively associated with sensory pain and palliative coping was positively associated with affective pain. At 1 year, pain intensity was predicted by baseline pain intensity, duration of symptoms, use of disease-modifying antirheumatic drugs (DMARDs), and emotional coping. Sensory pain was predicted by baseline sensory pain and DMARD use. Affective pain was predicted by baseline affective pain, DMARD use, and emotional coping. Conclusion. The majority of treated EIP patients can expect improvements in clinical and psychosocial variables over the first year of their illness. Emotional coping at baseline may contribute to pain in the future, and therefore it may be useful for patients to learn other means of dealing with this chronic disease.

“…Despite a number of published studies examining patients' preferences for drug treatments in rheumatoid arthritis (RA) (21)(22)(23)(24)(25)(26)(27)(28)(29), few have looked at parents' preferences for drug treatments in JIA. Barron et al (30) focused on parents' preferences for nonsteroidal antiinflammatory drug (NSAID) treatments in JIA, using contingent valuation to examine parents' willingness to pay for a drug that leads to remission over one that eliminates gastrointestinalrelated side effects.…”

Section: Introductionmentioning

confidence: 99%

Parents' preferences for drug treatments in juvenile idiopathic arthritis: A discrete choice experiment

Burnett

Regier

Feldman

et al. 2012

Objective. To examine parents' preferences for drug treatments and health outcomes in juvenile idiopathic arthritis (JIA) and identify demographic and health-related factors that significantly impact choice. Methods. A discrete choice experiment was conducted with 105 parents of children with JIA who were cared for by a rheumatologist at The Hospital for Sick Children in Canada. Attributes evaluated included "drug treatment," "child reported pain from arthritis," "participation in daily activities," "side effects," "days missed from school," and "cost to you." Multinomial logit regression was used to estimate the relative importance of each attribute level and interaction term. Results. Parents made tradeoffs between characteristics of the drug treatments and health outcomes. "Participation in daily activities" was the most important attribute, followed by "child reported pain from arthritis" and "cost to you." Parents of children with longer disease durations had stronger preferences for improved participation in daily activities, whereas parents of older JIA patients had stronger preferences for improved control of pain. Conclusion. Parents of children with JIA demonstrated strong preferences for treatments that reduce pain and improve daily functioning regardless of the associated side effects, level of responsibility required for drug administration, and days missed from school. Parents of children with longer disease durations and those who had been prescribed aggressive therapies had a greater preference for treatment effectiveness. These findings support the need for considering parental preferences in decisions regarding the choice of treatment for JIA.