Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis : what is the role of inflammation control?
(2023) In Scandinavian Journal of Rheumatology- Abstract
Objective: While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. Method: Bionaïve PsA patients starting a first anti-TNF therapy 2004–2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3,... (More)
Objective: While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. Method: Bionaïve PsA patients starting a first anti-TNF therapy 2004–2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression. Results: Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator’s global assessment were associated with a lower risk of 12-month refractory pain. Conclusions: A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.
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- author
- Roseman, C. LU ; Wallman, J. K. LU ; Jöud, A. LU ; Schelin, M. E.C. LU ; Einarsson, J. T. LU ; Lindqvist, E. LU ; Lampa, J. ; Kapetanovic, M. C. LU and Olofsson, T. LU
- organization
-
- Rheumatology
- Lund Arthritis Research Group (LARG) (research group)
- Division of Occupational and Environmental Medicine, Lund University
- Epidemiology (research group)
- Applied epidemiology (research group)
- EpiHealth: Epidemiology for Health
- Respiratory Medicine, Allergology, and Palliative Medicine
- LUCC: Lund University Cancer Centre
- The Institute for Palliative Care (research group)
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- in press
- subject
- in
- Scandinavian Journal of Rheumatology
- publisher
- Taylor & Francis
- external identifiers
-
- scopus:85178437680
- pmid:38031733
- ISSN
- 0300-9742
- DOI
- 10.1080/03009742.2023.2258644
- language
- English
- LU publication?
- yes
- id
- 19967091-fc0c-41ab-8930-b50713094052
- date added to LUP
- 2024-01-08 08:40:16
- date last changed
- 2024-06-18 09:12:03
@article{19967091-fc0c-41ab-8930-b50713094052, abstract = {{<p>Objective: While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. Method: Bionaïve PsA patients starting a first anti-TNF therapy 2004–2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression. Results: Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator’s global assessment were associated with a lower risk of 12-month refractory pain. Conclusions: A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.</p>}}, author = {{Roseman, C. and Wallman, J. K. and Jöud, A. and Schelin, M. E.C. and Einarsson, J. T. and Lindqvist, E. and Lampa, J. and Kapetanovic, M. C. and Olofsson, T.}}, issn = {{0300-9742}}, language = {{eng}}, publisher = {{Taylor & Francis}}, series = {{Scandinavian Journal of Rheumatology}}, title = {{Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis : what is the role of inflammation control?}}, url = {{http://dx.doi.org/10.1080/03009742.2023.2258644}}, doi = {{10.1080/03009742.2023.2258644}}, year = {{2023}}, }