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Predictors of unacceptable pain and the impact of sociodemographic factors and comorbidities—results from a large, nationwide cohort of early rheumatoid arthritis

Eberhard, Anna LU ; Giuseppe, Daniela Di ; Bergman, Stefan LU ; Lampa, Jon ; Mandl, Thomas LU orcid ; Olofsson, Tor LU ; Waldenlind, Kristin ; Askling, Johan and Turesson, Carl LU (2026) In Annals of the Rheumatic Diseases
Abstract

Objectives: The purpose of this paper is to investigate baseline predictors of unacceptable pain, overall and in patients with low inflammatory activity, as well as of pain over time, in patients with early rheumatoid arthritis (RA). Methods: We studied patients newly diagnosed with RA in Sweden in 2012-2020 (N = 10297), using data from several national registers. Pain was assessed by a Visual Analogue Scale (VAS; 0-100 mm). Unacceptable pain was defined as VAS pain > 40 mm, and low inflammation as C-reactive protein < 10 mg/L. Baseline predictors of unacceptable pain and unacceptable pain with low inflammation were evaluated using logistic regression analysis. Predictors of pain over time, from baseline to the 2-year follow-up,... (More)

Objectives: The purpose of this paper is to investigate baseline predictors of unacceptable pain, overall and in patients with low inflammatory activity, as well as of pain over time, in patients with early rheumatoid arthritis (RA). Methods: We studied patients newly diagnosed with RA in Sweden in 2012-2020 (N = 10297), using data from several national registers. Pain was assessed by a Visual Analogue Scale (VAS; 0-100 mm). Unacceptable pain was defined as VAS pain > 40 mm, and low inflammation as C-reactive protein < 10 mg/L. Baseline predictors of unacceptable pain and unacceptable pain with low inflammation were evaluated using logistic regression analysis. Predictors of pain over time, from baseline to the 2-year follow-up, were investigated using linear mixed-effect models. Results: Of the 3427 patients with data at 2 years, 1143 (33%) had unacceptable pain, and 808 (26%) had unacceptable pain with low inflammation. Female sex, worse patient-reported outcomes (PROs), low parameters of inflammation, and having many tender compared with swollen joints were baseline predictors of unacceptable pain and unacceptable pain with low inflammation at 1 and 2 years, and of more pain over time. Smoking, non-European origin, and having a psychiatric or pain-related comorbidity were also associated with more pain over time. Conclusions: Factors beyond inflammation contribute significantly to unacceptable pain at follow-up in RA. Physicians should be aware of the increased risk of unacceptable pain in patients with worse PROs and with discrepancies between the number of tender and swollen joints. Sex and cultural differences also need to be considered in future pain interventions in early RA.

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Contribution to journal
publication status
epub
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in
Annals of the Rheumatic Diseases
publisher
BMJ Publishing Group
external identifiers
  • scopus:105042290941
  • pmid:42321108
ISSN
0003-4967
DOI
10.1016/j.ard.2026.05.028
language
English
LU publication?
yes
id
0b80c37c-eacf-46e7-9940-f903c426d7ae
date added to LUP
2026-09-02 11:51:26
date last changed
2026-09-16 12:37:32
@article{0b80c37c-eacf-46e7-9940-f903c426d7ae,
  abstract     = {{<p>Objectives: The purpose of this paper is to investigate baseline predictors of unacceptable pain, overall and in patients with low inflammatory activity, as well as of pain over time, in patients with early rheumatoid arthritis (RA). Methods: We studied patients newly diagnosed with RA in Sweden in 2012-2020 (N = 10297), using data from several national registers. Pain was assessed by a Visual Analogue Scale (VAS; 0-100 mm). Unacceptable pain was defined as VAS pain &gt; 40 mm, and low inflammation as C-reactive protein &lt; 10 mg/L. Baseline predictors of unacceptable pain and unacceptable pain with low inflammation were evaluated using logistic regression analysis. Predictors of pain over time, from baseline to the 2-year follow-up, were investigated using linear mixed-effect models. Results: Of the 3427 patients with data at 2 years, 1143 (33%) had unacceptable pain, and 808 (26%) had unacceptable pain with low inflammation. Female sex, worse patient-reported outcomes (PROs), low parameters of inflammation, and having many tender compared with swollen joints were baseline predictors of unacceptable pain and unacceptable pain with low inflammation at 1 and 2 years, and of more pain over time. Smoking, non-European origin, and having a psychiatric or pain-related comorbidity were also associated with more pain over time. Conclusions: Factors beyond inflammation contribute significantly to unacceptable pain at follow-up in RA. Physicians should be aware of the increased risk of unacceptable pain in patients with worse PROs and with discrepancies between the number of tender and swollen joints. Sex and cultural differences also need to be considered in future pain interventions in early RA.</p>}},
  author       = {{Eberhard, Anna and Giuseppe, Daniela Di and Bergman, Stefan and Lampa, Jon and Mandl, Thomas and Olofsson, Tor and Waldenlind, Kristin and Askling, Johan and Turesson, Carl}},
  issn         = {{0003-4967}},
  language     = {{eng}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Annals of the Rheumatic Diseases}},
  title        = {{Predictors of unacceptable pain and the impact of sociodemographic factors and comorbidities—results from a large, nationwide cohort of early rheumatoid arthritis}},
  url          = {{http://dx.doi.org/10.1016/j.ard.2026.05.028}},
  doi          = {{10.1016/j.ard.2026.05.028}},
  year         = {{2026}},
}