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

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.

Depression as a major determinant of PASS (Patient’s Acceptable Symptoms State) in rheumatoid arthritis: a cross-sectional study in Brazilian patients

“…The proportion of patients in the PASS in this study was similar to that found in a Swedish sample of patients treated and followed by 5 years, reaching low disease activity (of 22.5%) 2 ; it was lower than that found in a Norwegian study that encompassed 1,496 patients (36.8%) 12 . In this study, disease activity, loss of function, pain, anxiety, and depression are associated with this dissatisfaction.…”

“…The disease activity has also been linked to PASS in several other studies 2,13 . Cutoff values for composite indices were examined in this context and found compatible with moderate disease activity.…”

“…Rheumatoid arthritis (RA) is an autoimmune inflammatory disease with profound repercussions on the patient’s well-being. Chronic pain, restriction of activities, and fatigue after the chronic articular inflammatory process interfere with the patient’s daily activity and are frequently associated with disability, depression, and anxiety 1 , 2 .…”

Patient reported outcomes and joint tenderness at three months-follow up better predict long term pain than baseline characteristics – an early rheumatoid arthritis cohort study

“…Limitations of the study include the modest sample size, partly resulting from missing data, especially for pain, PGA and HAQ, leading to a risk of type II error. Furthermore, there might be a selection bias, for patients with more severe disease in the SRQ, which could explain the higher proportion of patients with anti-CCP antibodies in this cohort compared to our previous study (12). Finally, there was no standardised protocol for joint assessments, and different physicians examined the patients during follow-up visits as standard clinical practice, which could lead to discrepancies in the assessment of tender and swollen joints.…”

Inflammation-induced mitochondrial and metabolic disturbances in sensory neurons control the switch from acute to chronic pain

“…However, in 12-30% of rheumatic arthritis patients pain persists while they have minimal joint inflammation or are in remission. [2] Accumulating evidence indicates that pain resolution after tissue damage or inflammation is not passive, but rather an active process that involves endogenous pain-resolution mechanisms. [3] Failed pain resolution pathways may lead to the transition from acute to chronic pain.…”