Session Type: Poster Session (Sunday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Persisting pain (NRS ≥4,) (PP) and non-articular pain (NAP), reduces quality of life for patients with RA. NAP is often attributed to fibromyalgia (FM), though FM prevalence could be overestimated in patients with unrecognized regional pain (RP) syndromes. Our goal was to understand pain patterns (regional vs. widespread) and its impact on achieving remission in real-world early inflammatory arthritis (EIA) patients.
Methods: Data were from EIA patients (symptoms < 1 year) enrolled in a national prospective cohort study between Mar 2017 – Mar 2019 who completed body pain diagrams (BPD) at baseline (n=317) and repeat assessments every 3-months over 1 year follow up (n=122). Patients were grouped by pattern of NAP reported in left, right, upper, lower and central regions (max 5 regions) as follows: 1. none, 2. regional pain (RP) if 1 or 2 painful regions and 3. widespread pain (WSP) if 3-5 painful regions. We compared sociodemographic, RA clinical and patient reported outcome measures across patient pain groups at baseline as well as associations between pain patterns and achievement of ACR Boolean Remission and DAS Remission, with and without inclusion of patient global assessment at 6 and 12 months. Logistic regression was used to estimate age and sex, and multiple adjusted associations between RP and WSP with remission.
Results: Of 317 eligible patients, the mean (sd) age was 56 (14), baseline DAS28 was 4.9 (1.3); 199 (63%) were female, 225 (71%) met one or both 1987/2010 RA criteria and 287 (91%) were treated with csDMARDS +/- MTX. There were more patients with RP compared to WSP throughout the study period (Figure 1). Patients with no NAP (Gp 1) and RP (Gp 2) had lower scores on the RA-FQ, MDHAQ, and Fatigue. Similarly, patient pain ratings, PtGA, PHQ scores were lower in groups 1 and 2 vs group 3 (Table 1). PtGA was most discordant from MDGA in the WSP group. Depressive Symptoms were lowest in the no pain group as was the mean(sd) DAS28 at baseline (4.8 (1.4)). Patients with RP or no pain smoked less than those with WSP. Age/sex adjusted and fully adjusted logistic regression models predicting associations with remission are shown in table 2. Regional pain was significantly associated with reduced odds of Boolean remission at 6 months, and widespread pain tended to be associated with lower odds of Boolean remission at 6- and 12 months and lower odds of DAS28 remission at 12-months though the sample with widespread pain was small and confidence intervals were inconclusive.
Conclusion: Early RA patients frequently experienced regional and widespread non-articular pain, though regional pain is more common, perhaps reflecting strain injuries following a period of active RA with consequent sarcopenia. Results suggest non-articular pain tended towards fewer patients achieving remission. Clinicians should consider whether their patients have non-articular pain and address these separately to provide more holistic care. Non-articular pain may falsely lower remission status. Awareness of this is needed when implementing targeted care strategies.
To cite this abstract in AMA style:Bykerk V, Schieir O, Valois M, Boire G, Hazlewood G, Bessette L, Hitchon C, Tin D, Thorne C, Keystone E, Pope J, Bartlett S, (CATCH) Investigators C. Persistent and Non-Articular Regional and Widespread Pain Are Common in Early Rheumatoid Arthritis, Impacting Remission Rates and Reflected in Patient Global Scores [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/persistent-and-non-articular-regional-and-widespread-pain-are-common-in-early-rheumatoid-arthritis-impacting-remission-rates-and-reflected-in-patient-global-scores/. Accessed June 5, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/persistent-and-non-articular-regional-and-widespread-pain-are-common-in-early-rheumatoid-arthritis-impacting-remission-rates-and-reflected-in-patient-global-scores/