ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2873

Remaining Pain and Widespread, Non-Inflammatory Pain Distribution during the First 12 Months after RA Diagnosis

Yvonne C. Lee1, Orit Schieir2, Marie-France Valois3, Susan J. Bartlett4, Gilles Boire5, Boulos Haraoui6, Carol A Hitchon7, Edward C. Keystone8, Diane Tin9, Carter Thorne10, Janet E. Pope11 and Vivian P. Bykerk12, 1Northwestern University Feinberg School of Medicine, Chicago, IL, 2McGill University, Montreal, ON, Canada, 3McGill University, Montreal, QC, Canada, 4Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 5Rheumatology Division, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, Sherbrooke, QC, Canada, 6Institut de Recherche en Rhumatologie de Montréal (IRRM), Montreal, QC, Canada, 7University of Manitoba, Winnipeg, MB, Canada, 8Mount Sinai Hospital, Toronto, ON, Canada, 9The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 10University of Toronto, Newmarket, ON, Canada, 11Department of Medicine, University of Western Ontario, London, ON, Canada, 12Hospital for Special Surgery, New York, NY

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: , , ,

Session Information

Date: Tuesday, October 23, 2018

Title: 5T108 ACR Abstract: RA–DX, Manifestations, & Outcomes V: Outcomes Measures (2868–2873)

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: The incidence of fibromyalgia is highest in the first 12 months after RA diagnosis,1 indicating that this period may represent a critical window during which acute inflammatory pain transitions to chronic non-inflammatory pain. With this study we aimed to describe the evolution of pain characteristics during the first 12 months after RA diagnosis and to identify predictors of remaining pain and widespread pain distribution ("fibromyalgic RA") at 12 months.

Methods: Data were obtained from early RA patients in the Canadian Early Arthritis Cohort (CATCH), a prospective inception cohort. The primary outcomes were: 1) remaining pain above the Patient Acceptable Symptom State (PASS), defined as a score >4 on a pain intensity numerical rating scale (NRS, range 0-10), and 2) widespread pain distribution (or "fibromyalgic RA"), defined by tender joint count (TJC28) – swollen joint count (SJC28) ≥ 7 .2,3 Descriptive statistics were used to summarize distributions of remaining pain and widespread pain over 12 months. Univariate and multivariable logistic regression models were used to identify predictors of remaining pain and widespread pain distribution at 12 months.

Results: 1,270 patients were included, with mean (SD) age of 53.9 (14.5), symptom duration of 5.8 (3.0) months and baseline DAS28 of 5.0 (1.4). The percentage of patients with remaining pain decreased from 64% at baseline to 24% at 12 months, and the percentage of patients with a widespread pain distribution decreased from 9% to 5%. The strongest predictors of 12-month remaining pain were sleep problems (highest quartile OR 2.2, 95% CI 1.2-3.9), pain intensity > 4/10 (OR 2.1, 95% CI 1.3-3.4), and higher HAQ-Disability Index (DI) score (OR 1.5, 95% CI 1.1-2.0). The strongest predictors of 12-month adjusted pain distribution were higher HAQ-DI score (OR 1.8, 95% CI 1.1-3.1) and higher number of comorbidities (OR 1.2, 95% CI 1.0-1.5). Baseline non-MTX, conventional synthetic DMARD (csDMARD) was associated with lower likelihood of widespread pain (OR 0.5, 95% CI 0.3-0.8).

Conclusion: Despite improvements in pain during the first year after RA diagnosis, 24% continued to report remaining pain above the PASS, and 5% reported widespread pain at 12 months. Baseline measures of sleep, pain intensity and disability were the strongest predictors of 12-month remaining pain. Disability and comorbidities were the strongest predictors of widespread pain distribution. Inflammatory markers were not associated with12-month remaining pain or pain distribution.

References:

1. Lee YC et al. Ann Rheum Dis. 2013;72:649-54

2. Tubach F et al. Arthritis Care Res. 2012;64:1699-707

3. Pollard LC et al. Rheumatology. 2010;49:924-8

 

Table. Multivariable logistic regression models for the association between baseline characteristics and a) remaining pain (pain NRS > 4), and b) widespread pain distribution (TJC28-SJC28 > 7).

Baseline characteristics

Remaining Pain1

OR, 95% CI

Widespread pain2

OR, 95% CI

Age (for change of 10 yrs)

0.8 (0.7, 1.0)

0.7 (0.6, 0.9)

Baseline pain intensity > 4/10

2.1 (1.3, 3.4)

2.1 (0.8, 5.4)

Sleep problems, quartiles

 

 

   ≥0 and ≤2

REF

REF

   >2 and ≤5

1.8 (1.1, 3.1)

0.7 (0.3, 1.9)

   >5 and ≤8

1.8 (1.1, 3.0)

0.9 (0.4, 2.2)

   >8 and ≤10

2.2 (1.2, 3.9)

1.0 (0.3, 2.7)

   Missing

0.6 (0.1, 5.6)

2.2 (0.2, 24.3)

HAQ-DI

1.5 (1.1, 2.0)

1.8 (1.1, 3.1)

Number of comorbidities

1.1 (1.0, 1.3)

1.2 (1.0, 1.5)

Non-MTX csDMARD use

0.8 (0.6, 1.1)

0.5 (0.3, 0.8)

1Adjusted for sex, education, income, SJC28, ESR, depression, back pain, osteoarthritis, MTX use, NSAID use

2Adjusted for sex, SJC28, ESR, depression, back pain, osteoarthritis, MTX use, NSAID use, baseline pain distribution

 

 

Disclosure: Y. C. Lee, Multiple, 2; O. Schieir, Other, 2; M. F. Valois, Other, 2; S. J. Bartlett, Multiple, 2, 5; G. Boire, Multiple, 2, 6; B. Haraoui, Multiple, 2, 6; C. A. Hitchon, Multiple, 2; E. C. Keystone, Multiple, 2; D. Tin, Multiple, 2; C. Thorne, Multiple, 2; J. E. Pope, Multiple, 2; V. P. Bykerk, Multiple, 2.

To cite this abstract in AMA style:

Lee YC, Schieir O, Valois MF, Bartlett SJ, Boire G, Haraoui B, Hitchon CA, Keystone EC, Tin D, Thorne C, Pope JE, Bykerk VP. Remaining Pain and Widespread, Non-Inflammatory Pain Distribution during the First 12 Months after RA Diagnosis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/remaining-pain-and-widespread-non-inflammatory-pain-distribution-during-the-first-12-months-after-ra-diagnosis/. Accessed .

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