The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study

Abstract

IntroductionDespite recent advances in anti-inflammatory therapy, rheumatoid arthritis (RA) patients continue to rate pain as a priority. The etiology of RA pain is likely multifactorial, including both inflammatory and non-inflammatory components. In this study, we examine the association between disease activity, sleep, psychiatric distress and pain sensitivity in RA.MethodsFifty-nine female RA patients completed questionnaires and underwent pressure pain threshold testing to assess hyperalgesia/allodynia at joint and non-joint sites. Blood samples were taken to measure C-reactive protein (CRP). The association between disease activity, sleep problems, psychiatric distress and pain threshold was assessed using Pearson/Spearman correlations and multivariable linear regression. Disease activity levels, sleep problems and psychiatric distress were compared between RA patients with fibromyalgia and RA patients without fibromyalgia.ResultsIn unadjusted analyses, CRP was not correlated with pain threshold, but tender joint count was inversely correlated with pain threshold at all sites (P ≤ 0.004). Sleep problems were associated with low pain threshold at all sites (P ≤ 0.0008). Psychiatric distress was associated with low pain threshold at the wrist and thumbnail (P ≤ 0.006). In multivariable linear regression models, CRP was inversely associated with wrist pain threshold (P = 0.003). Sleep problems were inversely associated with pain threshold at all sites (P ≤ 0.01), but psychiatric distress was not. Despite differences in pain threshold, CRP levels and sleep problems between RA patients with fibromyalgia and those without fibromyalgia, associations between these variables did not change when patients with fibromyalgia were excluded.ConclusionsMultivariable models are essential in analyses of pain. Among RA patients, inflammation is associated with heightened pain sensitivity at joints. In contrast, poor sleep is associated with diffuse pain sensitivity, as noted in central pain conditions such as fibromyalgia. Future studies examining pain sensitivity at joint and non-joint sites may identify patients with different underlying pain mechanisms and suggest alternative approaches to treating RA pain.

Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis

“…In a survey on the relationship between RA activity, sleep, psychiatric distress and pain sensitivity indicated no significant relation between pains with QOL but the sleep disorders had direct and significant relation with pain. 16 In this study we observed significant difference between QOL with various aspects of sleep. Our findings indicated that there were significant relations between apnea, twitch leg during sleep, numbness of legs with the QOL.…”

“…12 Moreover, some disturbances during sleep cause cardiovascular diseases, 13 behavioral disturbances, depression 14 and anxiety. 15 Reduction of general health, pain and negative effects on quality of life are common in RA, 16 however fewer researches have been done on sleep disorders of patients with RA. Although new methods for RA have been presented with new medical technology, but there have not been significant outcomes in solving the psychosocial and sleep problems of these patients.…”

Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate

“…It has been suggested previously that the development of generalized and widespread pain in RA may be in large part related to the inflammatory impact on the peripheral nerves 21. Thus, inflammatory actions on nerve endings, including nociceptive fibers, may result in long‐term sensitization, which contributes to chronic pain conditions.…”

Editorial: Synovitis and Pain Sensitization

“…Indeed, augmented central pain processing is associated with more severe pain, and normalization of central pain processing accompanies pain relief after arthroplasty (5,6). However, in inflammatory arthritis models central sensitization develops alongside synovitis (7), and widespread reduced pressure pain thresholds are associated with inflammatory disease activity in rheumatoid arthritis (RA) (8,9). Central sensitization might therefore be mediated by inflammation, rather than its accompanying pain, and widespread augmentation of central pain processing might be driven by circulating factors such as cytokines (10) rather than directly by nociceptive drive.…”