Session Information
Date: Wednesday, November 11, 2015
Title: Pain: Clinical Aspects
Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
Background/Purpose:
Chronic pain is common in RA and considered as the major disease burden from the patients’ perspective. Earlier data suggest that omega-3 fatty acids, vitamin D and vitamin C are anti-inflammatory and can decrease disease activity in RA. Also, excessive intake of omega-6 fatty acids has been linked with inflammation. However, little is known how these dietary factors may affect pain in RA. Our aim was to study the association between diet and pain, in spite of inflammation, after three months of MTX treatment in early RA patients.
Methods:
We included newly diagnosed RA patients with MTX monotherapy from Epidemiological Investigation of Rheumatoid Arthritis (EIRA) linked to clinical data in the Swedish Rheumatology Quality register (SRQ). Dietary data based on food frequency questionnaires were linked with data on pain after three months of MTX treatment. Pain in spite of inflammatory control (remaining pain) was defined based on the patient acceptance of symptoms scale (PASS) (1) together with low systemic inflammation (VAS>40 + CRP<10) at the three months follow-up. Associations between dietary nutrient intake and remaining pain were analyzed with logistic regression, adjusted for age, sex and BMI.
Results:
This study included 628 RA patients. 70.1% were females and the median age was 55 years. 68.0% were ACPA positive. Mean values for clinical measures: DAS28 5.1, VAS pain 53.8 and HAQ 1.0. All patients received MTX monotherapy and the mean BMI was 25.8 kg/m2.
After three months of MTX treatment, 103 patients (16.4%) had remaining pain. Higher intake of omega-3, vitamin D and vitamin C were inversely associated with remaining pain (OR=0.4[95% CI: 0.2-0.7], OR=0.5[95% CI: 0.3-0.8] and OR=0.5[95% CI: 0.3-0.9], respectively), whereas a higher omega-6:3 ratio was associated with increased risk of remaining pain (OR=2.7[95% CI: 1.6-4.7]). Adjustment for ACPA status did not change the ORs markedly.
Conclusion:
Intake of anti-inflammatory fatty acids and antioxidants are known to affect disease activity, and here we show that also pain may be affected, regardless of inflammation. Our findings reflect an inverse association between increased intake of omega-3, vitamin D and vitamin C, respectively and remaining pain. In addition, higher omega-6:3 ratio was found to associate with increased pain. These effects were independent of inflammation. Altogether, our data indicate that omega-3, vitamin D and vitamin C may dampen the development of chronic pain in early RA.
Reference:
1. Tubach F et al, Arthritis Care Res (Hoboken). 2012;64(11):1699-707.
To cite this abstract in AMA style:
Lourdudoss C, Wolk A, Alfredsson L, Klareskog L, van Vollenhoven RF, Lampa J. Dietary Intake of Omega-3 Fatty Acids and Vitamin C and D Associate with Decreased Pain, Independent of Inflammation, in MTX Treated Early RA Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/dietary-intake-of-omega-3-fatty-acids-and-vitamin-c-and-d-associate-with-decreased-pain-independent-of-inflammation-in-mtx-treated-early-ra-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/dietary-intake-of-omega-3-fatty-acids-and-vitamin-c-and-d-associate-with-decreased-pain-independent-of-inflammation-in-mtx-treated-early-ra-patients/