Date: Friday, November 6, 2020
Session Type: Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Persistent pain can occur in early RA patients, despite improvement in synovitis and may be due to coexisting non-articular pain (NAP). Though NAP is often attributed to fibromyalgia and widespread NAP, regional NAP syndromes may be more common and under-recognized. The purpose of this study is to describe patterns of NAP, predictors of persistent NAP and impact on outcomes in the first year following early RA diagnosis.
Methods: Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2017-2019 who completed 0,6,12-month evaluations with patient-reported outcomes [PROs] and clinical data available. We used the McGill Body Pain Diagram (BPD) to classify patients as experiencing no NAP, regional (RP:1-2 regions) or widespread NAP (WP:3-5 regions). Multinomial regression was used to identify baseline predictors of persistent RP and WP at 12-months. Multi-adjusted GEE with linear and logit links were used to estimate time-varying associations of NAP patterns with outcomes updated at each time point.
Results: Study included 421 participants: 66% were female, with a mean(sd) age 56 (14); 72% were seropositive and 90% were treated with MTX ± csDMARDs as initial therapy. NAP at baseline was common (55%), with majority (62%) reporting regional NAP. NAP prevalence was 33% at 12 months ( Figure ). Female sex and baseline depressive symptoms were independent predictors of widespread NAP at 12 months while poorer function and lack of early MTX treatment independently predicted regional NAP, at 12 mos. Regional and widespread NAP were associated with lower likelihood of remission in adjusted models that accounted for changes in NAP and remission over time ( Table ).
Conclusion: NAP is commonly reported in early RA pts seen in real world settings. Regional NAP was more common than WSP at all time-points, but both NAP patterns were associated with lower odds of achieving remission targets by 12 months. These data support considering the role of NAP when assessing RA treatment efficacy during clinical visits and warrant different treatment approaches to reduce symptoms in RA patients receiving target-based care.
To cite this abstract in AMA style:Bykerk V, Schieir O, Valois M, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Pope J, Bartlett S, (CATCH) Investigators C. Regional and Widespread Patterns of Non-articular Pain Are Common at RA Diagnosis and Contribute to Poor Outcomes at 12 Months: A Prospective Study of Pain Patterns in Canadians with RA [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/regional-and-widespread-patterns-of-non-articular-pain-are-common-at-ra-diagnosis-and-contribute-to-poor-outcomes-at-12-months-a-prospective-study-of-pain-patterns-in-canadians-with-ra/. Accessed May 13, 2021.
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