Background/Purpose: Pain is a commonly reported cause of affliction in RA-patients, also after adequate anti-rheumatic treatment. The objective of this study was to investigate the prevalence of unacceptable pain in early RA-patients with good inflammation control after anti-rheumatic treatment and also how this condition may affect the risk of long-term fatigue, sleeping problems and continuous pain.

Methods: Data was compiled from the population-based case control study Epidemiological Investigation of Rheumatoid Arthritis (EIRA) and linked to the Swedish Rheumatology Quality Register (SRQ). All patients were diagnosed with RA according to the 1987 ACR criteria. Early RA-patients with follow-up data both from diagnosis, 1 year and 3 years after diagnosis were included (N=186; 75% women, median age at diagnosis 56 years). Unacceptable pain in spite of good inflammation control at the 1 year follow-up (in the following named “refractory pain”), was defined using the previously validated definition of unacceptable pain (Patient Acceptable Symptom State (PASS) VAS pain ≥ 40) (1), combined with CRP <10 g/L (depicting good inflammatory control). The associated risk for significant fatigue (VAS ≥40), sleeping problems (defined as quite big/very big problem by the patient) and current pain, minimal pain and maximal pain (VAS ≥40, VAS ≥20 and VAS 75^th percentile in the group; respectively) at 3 years follow-up was calculated using logistic regression, adjusted for age and sex.

Results: Although a majority of patients (85%) reached good inflammatory control at the 1 year follow-up, 28% of them had unacceptable pain according to PASS. After 3 years, 17% of all patients had sleeping problems and 26% had significant fatigue. Median VAS pain at 3 years was 11 mm. Refractory pain at 1 year was associated with an increased risk of fatigue OR= 2.80 [95% CI: 1.36-5.78] and sleeping problems OR= 4.64 [95% CI: 1.96-10.98] 3 years after diagnosis. Refractory pain also associated with an increased risk of both current pain at the 3 year follow-up OR= 5.17 [95% CI: 2.33-11.47], as well as minimal pain level OR= 5.32 [95% CI: 2.34-12.11] and maximal pain level OR= 5.38 [95% CI: 2.56-11.31] at the 3 year follow-up.

Conclusion: Approximately a quarter of RA-patients have unacceptable pain despite good inflammation control 1 year after diagnosis. This condition strongly predicts fatigue, sleeping problems and continuous pain 2 years later. These findings highlight the insufficiency of anti-rheumatic treatment to suppress long-term pain and fatigue, and support the importance of early acknowledgement and treatment of pain also in patients with good inflammation control.

References

1.            Tubach F, Ravaud P, Martin-Mola E, Awada H, Bellamy N, Bombardier C, et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study. Arthritis Care Res (Hoboken). 2012;64(11):1699-707.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-unacceptable-pain-and-the-risk-of-fatigue-and-sleeping-problems-in-early-rheumatoid-arthritis-patients/