Study: Pain persists even during treatment among patients with PsA

MADRID — Many patients with psoriatic arthritis being treated with biologic therapy reported ongoing pain, according to findings from a real-world data set presented at the EULAR Annual Congress.

“This analysis of real-world data suggests very seriously that at least a third of people with biologic therapy at present still have severe pain after therapy,” Philip G. Conaghan, MD, PhD, professor of musculoskeletal medicine at the University of Leeds in the United Kingdom, said. “This pain is associated with poor [quality of life] QoL, activity levels and work function.”

Conaghan and colleagues used real-world data to assess self-reported pain in patients who were receiving biologic therapy. They used the SF-36, EQ-5D, and health assessment questionnaire disability index (HAQ-DI) to determine outcomes, including the relationship of pain to QoL and work. The researchers also investigated pain medications used, general health QoL and physical function.

Most patients were receiving their first biologic therapy at the time of the study and most those patients were receiving a tumor necrosis factor inhibitor. The study included adult patients from 13 countries. The patients were treated with a disease-modifying antirheumatic drug for more than 3 months.

There were 782 patients included in the final analysis. Of this group, 259 patients reported no pain; 235 reported moderate pain; and 288 reported severe pain. Baseline data showed the three groups were similar in terms of age and time since diagnosis.

Results showed non-prescription pain medication use rates were 6.3% among patients with no pain compared with 13.6% among those with moderate pain and 25.4% in the severe pain group. Similarly, NSAID use was 20.5% in the no pain group, 23% in the moderate group and 32.6% for the severe group.

A diagram of SF-36 results showed statistically significant increases in mental, emotional, social, vitality and general health outcomes among patients with the highest levels of pain.

“A contraction of life happens with increasing pain,” Conaghan said.

Several EQ-5D domains were lower, including mobility, self-care, usual activities and anxiety or depression, among patients with increasing pain levels. Results of the HAQ-DI survey indicated pain levels of 0.08 in the lowest group, 0.45 in the middle group and 1.17 in the highest group. Unemployment rates were 19% in the lowest pain group, 10% in the middle group and 58.3% in the highest group.

Conaghan noted the data were not granular enough to determine the extent to which pain was due to inflammatory arthritis vs. other sources.

“We have to think about different mechanisms for drugs,” he said. “We also have to think about whole patients, not just inflammatory arthritis.” — by Rob Volansky

References:

Conaghan PG, et al. Abstract #OP0107. Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.

Disclosure: Conaghan reports consulting for AbbVie, Eli Lilly, Novartis and Pfizer; and being on the speakers bureau for AbbVie, BMS and Roche.