Background/Purpose: Pain in rheumatoid arthritis (RA) has been thought to be due to nociceptive pain, but it was reported recently to include a mechanism associated with neuropathic pain as well. We therefore examined the frequency and clinical characteristics of RA patients with neuropathic-like pain.

Methods: Neuropathic-like pain in 145 outpatients (37 males, 108 femals) with RA was evaluated from December 2015 to July 2016 using the PainDETECT Questionnaire (PDQ), a screening tool for evaluating neuropathic pain. The disease activity was evaluated using the disease activity score of 28 joint (DAS28), clinical disease activity index (CDAI), and simplified disease activity index (SDAI). The following parameters were evaluated: swollen joint count on 28 joints (SJC), tender joint count on 28 joints (TJC), patient global assessment (PGA), estimator global assessment (EGA), pain visual analogue scale (PainVAS), serum C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The physical function was evaluated using the mHAQ-DI. The quality of pain was evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). The health-related quality of life was evaluated using the short-form 36-item health survey (SF-36). We compared the clinical parameters between the patients with (PDQ≥13) and without (PDQ≤12) neuropathic-like pain.

Results: Thirty (20.7%) of the 145 patients with RA had neuropathic-like pain according to the PDQ. In patients with neuropathic-like pain, the sex, PGA, EGA, PainVAS, TJC, DAS28, CDAI, SDAI, SF-MPQ sensory and affective scores, HAQ-DI, mental component summary scores (MCS), and role-social component summary scores (RCS) in SF-36 were significantly higher than in those without neuropathic-like pain. There were no significant differences in the RA patients with and without neuropathic-like pain in SJC, CRP, or ESR. In a multinomial logistic regression analysis, significant differences were found in the TJC (p=0.015, OR 1.54), physical component summary (PCS) scores (p=0.041, OR 0.959), MCS scores (p=0.024, OR 0.940), and RCS scores (p=0.021, OR 0.959) in SF-36.

Conclusion: Neuropathic-like pain in RA patients was associated with subjective indicators, including TJC and the health-related quality of life, rather than objective indicators of the disease activity, including SJC, CRP, and ESR. Proper treatment of neuropathic-like pain in RA patients may improve the health-related quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/neuropathic-like-pain-affects-the-tender-joint-count-and-health-related-quality-of-life-in-patients-with-rheumatoid-arthritis/