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.

Abstract

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.

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), https://doi.org/10.1002/acr.21723

• Journal Article Type: Article
• Acceptance Date: Apr 20, 2012
• Online Publication Date: May 3, 2012
• Publication Date: Sep 27, 2012
• Deposit Date: May 21, 2014
• Publicly Available Date: May 21, 2014
• Journal: Arthritis Care & Research
• Print ISSN: 2151-464X
• Electronic ISSN: 2151-4658
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: 10
• DOI: https://doi.org/10.1002/acr.21723
• Public URL: https://nottingham-repository.worktribe.com/output/711203
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/acr.21723/abstract
• 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