Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain.

IF 20.3 1区 医学 Q1 RHEUMATOLOGY
Christoph Baerwald, Edgar Stemmler, Sixten Gnüchtel, Katharina Jeromin, Björn Fritz, Michael Bernateck, Daniela Adolf, Peter C Taylor, Ralf Baron
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Abstract

Objectives: To determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity.

Methods: This prospective multicentre study included outpatients with RA scheduled for escalation of anti-inflammatory treatment due to active disease and severe pain (Disease Activity Score 28 (DAS28)>3.2 and Visual Analogue Scale (VAS)>50). At week 24, patients were stratified into reference group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score<50), non-responders (DAS28 improvement≤1.2 and DAS28>3.2, regardless of VAS pain score) and persisting pain group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score≥50). The former two subgroups ended the study at week 24. The latter continued until week 48. Demographic data, DAS28-C reactive protein, VAS for pain, painDETECT Questionnaire (PD-Q) to identify neuropathic pain (NeP) and the Pain Catastrophising Scale were assessed and tested for relation to persisting pain.

Results: Of 567 patients, 337 (59.4%) were classified as reference group, 102 (18.0%) as non-responders and 128 (22.6%) as patients with persisting pain. 21 (8.8%) responders, 28 (35.0%) non-responders and 27 (26.5%) persisting pain patients tested positive for NeP at week 24. Pain catastrophising (p=0.002) and number of tender joints (p=0.004) were positively associated with persisting pain at week 24. Baseline PD-Q was not related to subsequent persisting pain.

Conclusions: Persisting and non-nociceptive pain occur frequently in RA. Besides the potential involvement of NeP, pain catastrophising and a higher number of tender joints coincide with persisting pain.

类风湿性关节炎持续性剧烈疼痛的预测因素与疼痛起源和对疼痛的评价有关。
目的确定类风湿性关节炎(RA)患者中持续存在严重疼痛的比例,并确定尽管治疗控制了疾病活动,但仍存在疼痛的预测因素:这项前瞻性多中心研究纳入了因疾病活动和严重疼痛(疾病活动度评分 28 (DAS28)>3.2 和视觉模拟量表 (VAS)>50)而计划升级抗炎治疗的门诊类风湿关节炎患者。第24周时,患者被分为参照组(DAS28改善程度>1.2或DAS28≤3.2且VAS疼痛评分3.2,不考虑VAS疼痛评分)和持续疼痛组(DAS28改善程度>1.2或DAS28≤3.2且VAS疼痛评分≥50)。前两个亚组在第 24 周结束研究。后者则持续到第 48 周。研究人员评估了人口统计学数据、DAS28-C反应蛋白、VAS疼痛评分、识别神经病理性疼痛(NeP)的painDETECT问卷(PD-Q)和疼痛灾难化量表,并测试了它们与持续疼痛的关系:在 567 名患者中,337 人(59.4%)被列为参照组,102 人(18.0%)为无反应者,128 人(22.6%)为持续性疼痛患者。第 24 周时,21 名(8.8%)应答者、28 名(35.0%)非应答者和 27 名(26.5%)持续疼痛患者的 NeP 检测呈阳性。疼痛灾难化(p=0.002)和触痛关节数量(p=0.004)与第 24 周的持续疼痛呈正相关。基线 PD-Q 与随后的持续性疼痛无关:结论:RA患者经常出现持续性疼痛和非感觉性疼痛。结论:RA 患者经常出现持续性疼痛和非痛觉性疼痛,除了 NeP 的潜在参与外,疼痛灾难化和触痛关节数量增加也与持续性疼痛相吻合。
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来源期刊
Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases 医学-风湿病学
CiteScore
35.00
自引率
9.90%
发文量
3728
审稿时长
1.4 months
期刊介绍: Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.
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