Can unacceptable pain be predicted in patients with early rheumatoid arthritis based on inflammation?

This study investigated the duration, level, and predictors of unacceptable pain during the early stages of rheumatoid arthritis (RA), with and without low inflammation. The authors concluded that over a 5-year period, more than one-third of patients studied had unacceptable pain that was linked to lower swollen joints.

Pain during the early stages of RA is associated with inflammation of connective tissue joint linings (synovitis). Although disease-modifying anti-rheumatic drugs (DMARDs) have resulted in lowered inflammation, many patients still experience debilitating pain. Therefore, other causes of pain that are unrelated to inflammation may be important. Pain affects the quality of life (QoL) and can lead to depression, work disabilities, and sickness absences. Due to this, the most common goal for many patients with RA is pain reduction.

Recent study findings have identified patients during the early stages of RA development with low pain levels, highlighting the need for early pain management. The identification of early indicators of pain can better allow for targeted interventions in patients at higher risk of developing long-lasting pain.

The study included 232 patients with early RA. 179 patients were followed-up up to 5 years while receiving standard care. Patient-reported outcomes (PROs) and disease activity measures were collected. 

30.1% of patients had unacceptable pain after 1 year and 34.1% at 2 years. 34% of patients still had unacceptable pain at the 5-year follow-up period.

40 patients (22.5%) had unacceptable pain with low inflammation at the 5-year follow-up. Negative anti-CCP (anti-cyclic citrullinated peptide) results were a significant predictor of unacceptable pain with low inflammation.

Lower swollen joint counts, higher disease activity scores, and tender joints at the beginning of the study were predictors of pain after 5 years.

The study showed that over one-third of patients with early RA experienced long-lasting unacceptable pain. Most patients had pain despite the low inflammatory activity. Predictors of pain included high disease activity scores and lower swollen and tender joints.

Additional information on other existing conditions in patients was unavailable, so other causes of pain could not be evaluated. The number of patients included in the study was also small.