Background/Purpose: Despite advances in the treatments available for rheumatoid arthritis (RA), many patients continue to experience musculoskeletal pain. Untreated and under-treated pain are well known to increase disability and negatively impact overall well-being. Recently, multinational evidence based guidelines have been published in an attempt to improve overall pain management in these patients.  To date, no studies have evaluated the prevalence and magnitude or impact of pain on Australian patients with RA. The pattern and type of analgesics used is also not known. The purpose of this study was to determine the prevalence and severity of pain and its impact on functional capacity and quality of life in Australian patients with RA and to describe current analgesic use.

Methods: We performed a descriptive analysis from the Australian Rheumatology Association Database (ARAD). ARAD is a voluntary registry that collects longitudinal health outcome data from Australian patients with inflammatory arthritis (RA, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis). The latest data entry point between 1st Januray 2014 and 31st December 2014 for all adult patients (≥18 years) with RA was used. Patient demographics, pain scores (VAS 0-100mm), medication use, responses to the HAQ, Assessment of Quality of Life (AQOL), and European Quality of Life-5 Dimensions (EQ-5D) were extracted and analysed. For the prevalence calculation pain was defined as being present if >4mm (0-100mm VAS).

Results: In 2014, 1548 patients with RA (76% female, mean age 60 years (range 21 to 90, mean disease duration 19 years) completed an ARAD questionnaire. 85% were receiving biological therapy. Mean HAQ was 0.94 (SD 0.75), EQ-5D 0.65 (0.24), AQOL 0.56 (SD 0.24). Overall 95% of patients reported pain (>4mm) in the preceding week (mean 41.1mm, SD 25.7) with 37% having mild pain (5-34mm), 39% moderate pain (35-69mm) and 19% severe pain (70-100mm) . Females reported higher mean pain (42.3mm versus 37.2mm, p =0.001), as did those using biological agents (41.7mm versus 36.4mm, p=0.02) or receiving the disability pension (53mm versus 39mm, p<0.0001). Seventy-three percent of patients reported taking an analgesic medication, most commonly paracetamol (60%), NSAID (37%), opioid (26%), and/or an antidepressant/neuromodulator (1%). A single analgesic medication was used by 49%, with 37% taking two and 14% consuming three or more. Higher pain scores were associated with use of a higher number of analgesic medications (F (3,1542) = 79.2, p<0.0001), poorer quality of life (lower EQ-5D (ß=-0.01, p<0.0001), lower AQOL (ß=-0.01, p<0.0001)) and poorer function (higher HAQ (ß=0.02, p>0.0001)).  

Conclusion: Despite use of multiple analgesic medications, the prevalence of moderate to severe pain is high in patients with RA and is associated with lower levels of function and quality of life.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-pain-its-impact-and-management-in-a-population-based-cohort-of-patients-with-rheumatoid-arthritis-data-from-the-australian-rheumatology-association-database/