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Perspectives on Chronic Widespread Pain in Rheumatoid Arthritis

Aronsson, Maria LU orcid (2025) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Abstract:
Concomitant chronic widespread pain (CWP) in patients with rheumatoid arthritis (RA) continues to be a problem despite modern pharmacological treatment. The overall aim was to investigate factors involved in chronic widespread pain in rheumatoid arthritis.

Study I, compared patients with early RA (duration ≤12 months), in a tight control cohort, with conventionally managed patients. The patients in the tight control had significantly lower 28-joint disease activity score (DAS28), and reported less pain at 3, 6, 12 and 24 months, p ≤ 0.001. Participation in the tight control, was associated with remission and acceptable pain (VAS pain<40) at 24 months.

In Study II, the prevalence of CWP, was investigated... (More)
Abstract:
Concomitant chronic widespread pain (CWP) in patients with rheumatoid arthritis (RA) continues to be a problem despite modern pharmacological treatment. The overall aim was to investigate factors involved in chronic widespread pain in rheumatoid arthritis.

Study I, compared patients with early RA (duration ≤12 months), in a tight control cohort, with conventionally managed patients. The patients in the tight control had significantly lower 28-joint disease activity score (DAS28), and reported less pain at 3, 6, 12 and 24 months, p ≤ 0.001. Participation in the tight control, was associated with remission and acceptable pain (VAS pain<40) at 24 months.

In Study II, the prevalence of CWP, was investigated at 6-year follow-up, in both a tight control cohort and a conventional cohort of early RA. In the tight control cohort, 10% reported CWP with the 2019 criteria (CWP2019), compared to 23% in the conventional cohort, p=0.026. Participation in the conventional cohort, adjusted for disease duration, gender, age, and VAS pain at inclusion, had an association with CWP2019, OR 2.57 (95%CI 1.02-6.50). A high level of fear-avoidance about physical activity was associated with CWP2019.

Study III examined associations between the adipokine leptin, and CWP2019 in RA. Patients fulfilling CWP2019 had significantly higher leptin levels, waist circumference and BMI. There was a significant association between leptin levels and CWP2019 OR 1.014 (95% CI 1.007-1.020). The significant association remained when adjustments were made for BMI, gender and age.

In Study IV, the circadian rhythm of leptin release was explored in 11 patients with RA and 10 patients with osteoarthritis (OA). A circadian rhythm of leptin release was observed with a peak at night. The two thirds of patients that reported most pain, had numerically higher median leptin levels at all timepoints. The difference was significant or close to significant.

In conclusion, there is a possible connection between leptin and CWP in RA. However, the causes of CWP are multifactorial and factors such as tight control early in the disease course seem to have a potential to limit the development of CWP.
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author
supervisor
opponent
  • MD, Associate Professor Bjersing, Jan, University of Gothenburg
organization
alternative title
Perspektiv på långvarig spridd smärta vid reumatoid artrit
publishing date
type
Thesis
publication status
published
subject
keywords
pain RA leptin CWP
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2025:101
pages
89 pages
publisher
Lund University, Faculty of Medicine
defense location
Reumatologiska klinikens föreläsningssal, Lottasalen, Kioskgatan 5, Skånes Universitetssjukhus i Lund. Join by Teams: https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZjQyNTE5YmUtYjkxNC00OTljLWFjYmMtMmFlYTg3Y2YxYmU3%40thread.v2/0?context=%7b%22Tid%22%3a%226585ed5f-93d5-40d1-8dfb-48df526ff0f7%22%2c%22Oid%22%3a%225f282f28-b5d0-42f3-bcf0-a9a040e8fba4%22%7d
defense date
2025-10-10 09:00:00
ISSN
1652-8220
ISBN
978-91-8021-754-5
language
English
LU publication?
yes
id
f5e80b98-15f8-4cd3-80b9-cc2be0e5c47a
date added to LUP
2025-09-03 21:42:43
date last changed
2025-09-20 03:27:06
@phdthesis{f5e80b98-15f8-4cd3-80b9-cc2be0e5c47a,
  abstract     = {{Abstract:<br/>Concomitant chronic widespread pain (CWP) in patients with rheumatoid arthritis (RA) continues to be a problem despite modern pharmacological treatment. The overall aim was to investigate factors involved in chronic widespread pain in rheumatoid arthritis.<br/><br/>Study I, compared patients with early RA (duration ≤12 months), in a tight control cohort, with conventionally managed patients. The patients in the tight control had significantly lower 28-joint disease activity score (DAS28), and reported less pain at 3, 6, 12 and 24 months, p ≤ 0.001. Participation in the tight control, was associated with remission and acceptable pain (VAS pain&lt;40) at 24 months. <br/><br/>In Study II, the prevalence of CWP, was investigated at 6-year follow-up, in both a tight control cohort and a conventional cohort of early RA. In the tight control cohort, 10% reported CWP with the 2019 criteria (CWP2019), compared to 23% in the conventional cohort, p=0.026. Participation in the conventional cohort, adjusted for disease duration, gender, age, and VAS pain at inclusion, had an association with CWP2019, OR 2.57 (95%CI 1.02-6.50). A high level of fear-avoidance about physical activity was associated with CWP2019.<br/><br/>Study III examined associations between the adipokine leptin, and CWP2019 in RA. Patients fulfilling CWP2019 had significantly higher leptin levels, waist circumference and BMI. There was a significant association between leptin levels and CWP2019 OR 1.014 (95% CI 1.007-1.020). The significant association remained when adjustments were made for BMI, gender and age.<br/><br/>In Study IV, the circadian rhythm of leptin release was explored in 11 patients with RA and 10 patients with osteoarthritis (OA). A circadian rhythm of leptin release was observed with a peak at night. The two thirds of patients that reported most pain, had numerically higher median leptin levels at all timepoints. The difference was significant or close to significant. <br/><br/>In conclusion, there is a possible connection between leptin and CWP in RA. However, the causes of CWP are multifactorial and factors such as tight control early in the disease course seem to have a potential to limit the development of CWP.<br/>}},
  author       = {{Aronsson, Maria}},
  isbn         = {{978-91-8021-754-5}},
  issn         = {{1652-8220}},
  keywords     = {{pain RA leptin CWP}},
  language     = {{eng}},
  number       = {{2025:101}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Perspectives on Chronic Widespread Pain in Rheumatoid Arthritis}},
  url          = {{https://lup.lub.lu.se/search/files/227284580/Maria_Aronsson_-_WEBB.pdf}},
  year         = {{2025}},
}