Daniel F. McWilliams
Predictors of change in bodily pain in early rheumatoid arthritis: an inception cohort study
McWilliams, Daniel F.; Zhang, Weiya; Mansell, Josephine S.; Kiely, Patrick D.W.; Young, Adam; Walsh, David A.
Josephine S. Mansell
Patrick D.W. Kiely
David A. Walsh
Objective: To investigate possible predictors for lack of pain improvement after 1 year of treatment for early rheumatoid arthritis (RA).
Methods: The Early Rheumatoid Arthritis Network (ERAN) database was used for analysis of baseline and 1-year pain data. The ERAN is a hospital-based inception cohort of 1,189 people. Short Form 36 questionnaire bodily pain scores were used to calculate change in pain at 1 year as the outcome. The proportion of the Disease Activity Score in 28 joints (DAS28) attributable to patient-reported components (joint tenderness and visual analog scale score; DAS28-P) at baseline was derived as a predictor. Predictors of less improvement in pain were investigated using adjusted odds ratios (ORadj) generated by logistic regression, adjusting for 14 additional clinical and demographic covariates.
Results: Greater pain at baseline was associated with sex, high DAS28, worse mental health, and smoking. Most patients with early RA reported incomplete improvement in bodily pain after 1 year. The DAS28-P index did not significantly change in the patients whose disease remained active. Less improvement in pain was predicted by female sex (ORadj 3.41, 95% confidence interval [95% CI] 1.35–8.64) and a high DAS28-P index at baseline (ORadj for tertiles 2.09, 95% CI 1.24–3.55). Other conventional RA risk factors did not predict pain changes.
Conclusion: The factors most likely to predict less improvement in pain in early RA are female sex and a high DAS28-P index. A high DAS28-P index may reflect greater contributions of noninflammatory factors, such as central sensitization, to pain. Strategies in addition to inflammatory disease suppression may be required to adequately treat pain.
|Journal Article Type||Article|
|Publication Date||Sep 27, 2012|
|Journal||Arthritis Care & Research|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||McWilliams, D. F., Zhang, W., Mansell, J. S., Kiely, P. D., Young, A., & Walsh, D. A. (2012). Predictors of change in bodily pain in early rheumatoid arthritis: an inception cohort study. Arthritis Care and Research, 64(10), doi:10.1002/acr.21723|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0|
|Additional Information||McWilliams, D.F., Zhang, W., Mansell, J.S., Kiely, P.D.W., Young, A. and Walsh, D.A. (2012), Predictors of change in bodily pain in early rheumatoid arthritis: An inception cohort study. Arthritis Care Res, 64: 1505–1513. doi:10.1002/acr.21723|
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0
You might also like
The powerful placebo effect in osteoarthritis