Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis-an inception cohort study
(2021) In Arthritis Research & Therapy 23(1).- 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... (More)
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.
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- author
- Eberhard, Anna LU ; Bergman, Stefan LU ; Mandl, Thomas LU ; Olofsson, Tor LU ; Rydholm, Maria ; Jacobsson, Lennart LU and Turesson, Carl LU
- organization
- publishing date
- 2021-06-14
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Arthritis Research & Therapy
- volume
- 23
- issue
- 1
- article number
- 169
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:34127054
- scopus:85107919431
- ISSN
- 1478-6354
- DOI
- 10.1186/s13075-021-02550-7
- project
- Pain in early rheumatoid arthritis - predictors and development over time
- language
- English
- LU publication?
- yes
- id
- 860eb868-2151-4b8c-809e-018a0f34b704
- date added to LUP
- 2021-06-22 13:22:55
- date last changed
- 2024-06-15 12:47:04
@article{860eb868-2151-4b8c-809e-018a0f34b704,
abstract = {{<p>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.</p><p>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.</p><p>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)].</p><p>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.</p>}},
author = {{Eberhard, Anna and Bergman, Stefan and Mandl, Thomas and Olofsson, Tor and Rydholm, Maria and Jacobsson, Lennart and Turesson, Carl}},
issn = {{1478-6354}},
language = {{eng}},
month = {{06}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Arthritis Research & Therapy}},
title = {{Predictors of unacceptable pain with and without low inflammation over 5 years in early rheumatoid arthritis-an inception cohort study}},
url = {{http://dx.doi.org/10.1186/s13075-021-02550-7}},
doi = {{10.1186/s13075-021-02550-7}},
volume = {{23}},
year = {{2021}},
}