Lee et al., 2011

Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study

At a glance

Objective

To understand the degree to which pain persists in patients with DAS28CRP remission.

Related articles

For other articles casting doubt on the validity of the DAS28, see Salmeen et al., 2011.

Link

DOI: https://arthritis-research.biomedcentral.com/articles/10.1186/ar3353

Background

• Cause of pain in patients in remission unknown, but may be inflammation, structural joint damage, and / or non-disease-related factors

Methods

• 157 RA patients from the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS) at baseline and one-year follow up
• Multivariable-adjusted logistic regression onto pain with predictors disease-related predictors (such as MDHAQ function score, disease duration or patient global assessment … why is patient global assessment disease-related?), and others like fatigue, sleep problems

Results

• Cause of pain in patients in remission is not likely inflammation or structural joint damage, because CRP, swollen-joint count, and tender-joint count were not significantly associated with pain
• Function scores and patient global assessment were significantly associated with pain at baseline and one year follow up

Conclusion

• Function and patient global assessment are often interpreted as RA-related, but these measures also reflect a wide range of other factors
• For example, fibromyalgia is a non-inflammatory condition that is not associated with joint damage
• RA patients with fibromyalgia have much worse function but only slightly elevated sedimentation rate (inflammation)
• The strong association between baseline fatigue, sleep problems, poor self-efficacy and baseline and one-year pain severity supports the existence of an enhanced, non-inflammatory pain state (more on pain in fibromyalgia)