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Patients with established RA more likely to have FM, pain beyond joints
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Patients with longstanding, established rheumatoid arthritis were more likely to have fibromyalgia and pressure-induced, widespread pain in addition to joint pain, according to recently published data from researchers in the U.K.
Researchers studied 50 patients (RA, 76% female, mean age 60 years, 21% smokers) with stable, longstanding rheumatoid arthritis (RA) recruited from a rheumatology outpatient clinic. Some reported use of analgesics and all were being treated with traditional or biologic drug-modifying anti-rheumatic drugs (DMARDs) and/or glucocorticoids.
Patients were assessed for pain pressure thresholds (PPTs) using an electronic pressure algometer by the lead author. Pressure sensitivity was measured at sternum, medial knee and anterior tibia. The pressure was recorded at the pressure level in which pain was first reported.
Other data were collected, and the Disease Activity Score (DAS28), McGill Pain Questionnaire, Widespread Pain Index (WPI), Fatigue Severity Scale, Somatic Symptoms Scale (SSS), Beck Depression Index II and other surveys were administered.
Multivariable regression models were used to adjust for confounding variables, and multiple linear regression was used with continuous outcome variables. Binary logistic regression was used to calculate adjusted odds ratios for all covariables.
Current knee pain was reported in 40 patients (80%), and eight (16%) showed high disease activity (DAS28 greater than 5). DAS28 scores were higher in patients using biologics compared with traditional DMARDs or steroids, according to the researchers.
PPT values were lower, showing higher sensitivity to pressure-induced pain, at the anterior tibia and sternum than at the medial tibiofemoral joint line. PPT at each location was significantly correlated with PPT at each other site, and high PPT was associated with higher reported pain unrelated to the site, according to the researchers. Lower PPT was also linked to higher DAS28 scores.
Of the participants, 48% met criteria for fibromyalgia (FM) based on WPI and SSS scores and showed similar demographic makeup to other participants. No differences were seen in drug treatment type among those with FM, and no associations with tender or swollen joint count or erythrocyte sedimentation rate. Higher scores for fibromyalgia criteria were associated with lower PPTs and poorer mental health scores.
The researchers concluded that suppression of inflammation may not adequately reduce pain in patients with RA who may also have underlying FM symptoms. – by Shirley Pulawski
Disclosure:
Joharatnam has no relevant financial disclosures. Please see the full study for a complete list of the other authors’ financial disclosures.
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